CHAPTER 14 - Osteoporosis management

Abstract

Bone strengthening agents are medications that are used to improve bone strength to prevent fractures. There are two main categories of bone strengthening agents: antiresorptive medications, which inhibit osteoclastic bone resorption, and anabolic agents, which stimulate bone formation. Consideration should be given to using these medications in any patient who has osteoporosis by any of the 3 diagnostic criteria—a fragility fracture, bone mineral density T-score ≤ −2.5, or FRAX risk estimate of ≥ 3% for hip fractures and ≥ 20% for major osteoporosis fractures. All FDA approved osteoporosis medications have been proven in clinical trials to significantly reduce the risk of fragility fractures; side effects are uncommon and are unique to each class of medications. Two rare but notable complications, osteonecrosis of the jaw and atypical femoral fractures, occur only with the antiresorptive class of medications and do not occur with the anabolic agents. Preventive strategies for these complications include temporary discontinuation prior to invasive dental procedures and periodic antiresorptive drug holidays. Specific antiresorptive and anabolic medications have also been shown to prevent or reduce bone loss and decrease fracture risk in patients who are treated with chronic glucocorticoid therapy.