1st August 2023

Management

Initial non-pharmacological treatment:

• Treating any underlying or secondary causes
• Calcium and vitamin D supplements
• Reduce modifiable risk factors with lifestyle choices

Pharmacological treatment:

This usually commenced in men over 50 or post-menopausal women with a DEXA scan T-score result in keeping with osteoporosis. It is also given to people with a high risk of fracture according to the FRAX® score or to those with intermediate risk if awaiting a DEXA scan will significantly delay treatment as recommended by the National Osteoporosis Guideline Group (NOGG). In other specific circumstances, treatment is usually started by specialists, such as when patients are commenced on high dose prednisolone. Treatment options are listed below, with each medication tried individually and not in combination.

• Bisphosphonates – synthetic analogues of bone pyrophosphate. First line treatment is initially given orally (alendronate, risedronate or ibandronate). It can also be given as a one-yearly intravenous infusion of zoledronic acid. Due to the risk of atypical fractures with long term bisphosphonates, they are usually reviewed after taking the medication for 3-5 years.
• Denosumab – 6 monthly subcutaneous injections, monoclonal antibody, RANK Ligand inhibitor.
• Teriparatide – daily subcutaneous synthetic parathyroid hormone (PTH)
• Raloxifene – a selective oestrogen receptor modulator. Used in post-menopausal women.
• Strontium Ranelate – stimulates bone formation and reduces bone resorption