Osteoporosis Treatments

OSTEOPOROSIS TREATMENTS
Risk factors: age, gender, Asian or Caucasian descent, petite and thin women, prior osteoporotic fracture, femoral neck BMD, low BMI, rheumatoid arthritis, family or personal history of hip fractures, smoking, heavy alcohol intake, chronic glucocorticoid use, type 1 diabetes, hyperthyroidism, hypogonadism, menopause at <45yrs of age, malnutrition or malabsorption, chronic liver disease. Prevention: Recommended Calcium intake: 1–3yrs: 700mg; 4–8yrs: 1000mg; 9–18yrs: 1300mg; 19–50yrs: 1000mg; males 51–70yrs: 1000mg; females 51–70yrs, 71+yrs: 1200mg; pregnancy or nursing mothers: 1000–1300mg Recommended Vitamin D intake: >1yr: 600 IU/day; 50+yrs: 800–1,000 IU/day. Usually met through sunlight exposure. HRT if bone loss due to estrogen deficiency at menopause, initiate estrogen therapy at lowest effective dose. Individualize and reevaluate periodically. Intact uteri: prescribe progestin with estrogen. Hysterectomy: may prescribe estrogen continuously. Other: weight-bearing exercises, fall prevention, smoking cessation, alcohol restriction, weight and dietary management, preventative drug therapy
Generic	Brand	Strength	Form	Dose
BISPHOSPHONATES
alendronate	—	5mg, 10mg, 35mg, 40mg	tabs	Treatment: 10mg once daily or 70mg once weekly. Prevention: 5mg once daily or 35mg once weekly
	—	70mg/75mL	oral soln
	Binosto	70mg	effervescent tabs for oral soln	Treatment: 70mg once weekly
	Fosamax	70mg	tab	Treatment: 70mg once weekly Prevention: 35mg once weekly
alendronate/ cholecalciferol (Vit. D₃)	Fosamax Plus D	70mg/2800 IU, 70mg/5600 IU	tab	Treatment: 70mg/2800 IU or 70mg/5600 IU once weekly
ibandronate	—	150mg	tab	Prevention and Treatment: 150mg once monthly
ibandronate	—	3mg/3mL	IV inj	Prevention and Treatment: 3mg IV bolus over 15–30secs once every 3mos
risedronate	Actonel	5mg, 30mg, 35mg, 75mg, 150mg	tab	Postmenopausal: 5mg once daily or 35mg once weekly or one 75mg tab taken on 2 consecutive days per month or one 150mg tab once monthly. Glucocorticoid-induced: 5mg once daily. Osteoporosis in men: 35mg once weekly.
risedronate	Atelvia	35mg	delayed-release tabs	Treatment: 35mg once weekly
zoledronic acid	Reclast	5mg/100mL	IV inj	Treatment: 5mg IV infusion once a year Prevention: 5mg IV infusion once every 2yrs
CALCITONIN
calcitonin-salmon	—	200 IU/spray	nasal spray	Treatment: 1 spray in alternating nostril daily
calcitonin-salmon	Miacalcin	200 IU/mL	SC or IM inj	Treatment: 100 IU SC or IM daily
HORMONE REPLACEMENT THERAPY
conjugated estrogens	Miacalcin	Premarin	0.3mg, 0.45mg, 0.625mg, 0.9mg, 1.25mg	tab	0.3mg daily; adjust
conjugated estrogens/ bazedoxifene	Duavee	0.45mg/20mg	tab	1 tab daily
conjugated estrogens, then conjugated estrogens/ medroxyprogesterone	Premphase	0.625mg, then 0.625mg/5mg	tab	1 tab once daily in correct order (ie, 14 tabs of 0.625mg estrogen, then 14 tabs of 0.625mg estrogen/ 5mg of medroxyprogesterone; repeat)
conjugated estrogens/ medroxyprogesterone	Prempro	0.3mg/1.5mg, 0.45mg/1.5mg, 0.625mg/2.5mg, 0.625mg/5mg	tab	1 tab once daily
estradiol	Climara	0.025mg/day, 0.0375mg/day, 0.05mg/day, 0.06mg/day, 0.075mg/day, 0.1mg/day	transdermal system	0.025mg/day patch applied once weekly; adjust
	Estrace	0.5mg, 1mg, 2mg	tab	0.5mg daily
	Menostar	14mcg/day	transdermal system	1 patch once weekly
	Minivelle	0.025mg/day, 0.0375mg/day, 0.05mg/day, 0.075mg/day, 0.1mg/day	transdermal system	0.025mg/day patch twice weekly (every 3–4 days); adjust
	Vivelle-Dot	0.025mg/day, 0.0375mg/day, 0.05mg/day, 0.075mg/day, 0.1mg/day	transdermal system	0.025mg/day patch applied twice weekly
estradiol/ levonorgestrel	Climara Pro	0.045mg/0.015mg/day	transdermal system	1 patch once weekly
estradiol/ norethindrone acetate	Activella	0.5mg/0.1mg, 1mg/0.5mg	tab	1 tab once daily
norethindrone acetate/ ethinyl estradiol	—	0.5mg/2.5mcg, 1mg/5mcg	tab	1 tab once daily
INTERFERON
interferon gamma-1b	Actimmune	100mcg/0.5mL	SC inj	BSA ≤0.5m²: 1.5mcg/kg/dose 3 times weekly BSA >0.5m²: 50mcg/m² (1 million IU/m²) 3 times weekly
OSTEOCLAST INHIBITOR (RANKL INHIBITOR)
denosumab	Prolia	60mg/mL	SC inj	60mg once every 6mos
PARATHYROID HORMONE
teriparatide	—	250mcg/mL	SC inj	20mcg once daily. Consider treating for >2yrs only if patient remains at or has returned to having high risk for fracture.
teriparatide	Forteo	250mcg/mL	SC inj
PARATHYROID HORMONE RELATED PEPTIDE ANALOG
abaloparatide	Tymlos	2000mcg/mL	SC inj	80mcg once daily
Sclerostin Inhibitor
romosozumab-aqqg	Evenity	105mg/1.17mL	SC inj	210mg once monthly (given as 2 consecutive injs) for 12mos
SELECTIVE ESTROGEN RECEPTOR MODULATORs (SERMs)
raloxifene	Evista	60mg	tab	Prevention and Treatment: 60mg once daily
NOTES
Not an inclusive list of medications and/or official indications. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 4/2024)

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