Guidelines for Osteoporosis Treatment

Drug Treatment Plan Should Consider Risks and Benefits of Individual Patients

Medically Reviewed by Louise Chang, MD on September 15, 2008

Sept. 15, 2008 -- Drugs are helpful in treating osteoporosis, but figuring out which drug to prescribe means evaluating the pluses and minuses of each option for each patient, according to new recommendations from The American College of Physicians.

As people get older their bones become less dense and more vulnerable to fracture. In its severe form, this condition is known as osteoporosis. Osteoporosis is particularly common in women after menopause, though men get it too.

The American College of Physicians makes these news recommendations:

  • Doctors should offer drugs to people who have known osteoporosis and people who have experienced what's called a fragility fracture -- when a bone breaks without significant trauma.
  • Doctors should consider preventive treatment for patients at risk of getting osteoporosis, the guidelines say.
  • Doctors should take into account a patient's individual risk and benefits when selecting among drug treatment options for osteoporosis
  • Additional research should be done to investigate osteoporosis treatment in men and women.

The authors collectively reviewed data from several different drug studies to come up with their evidence-based guidelines.

Among the findings:

  • Bisphosphonates are used for prevention or treatment of osteoporosis. They reduce fractures, but there isn't good information on how long people should take these drugs. Adverse effects include acid reflux, and problems of the esophagus; a rare but serious side effect involves the breakdown of the jaw bone.
  • Estrogens reduce the incidence of fractures but can increase risk for some kinds of cancer, stroke, and blood clots.
  • A non-estrogen drug that focuses on estrogen receptors (also known as a SERM, or selective estrogen receptor modulator) prevents spinal fractures but doesn't reduce the likelihood of a hip fracture. Adverse effects include blood clots.
  • Calcitonin is used for treatment. The authors note fair-quality evidence that it reduces incidence of spine fractures, though evidence suggests calcitonin does not reduce other kinds of fractures. No clinically significant side effects are noted in the guideline.
  • Teriparatide is used for osteoporosis treatment. It prevents spine fractures, but evidence for other types of fractures are mixed. No clinically significant side effects are noted in the guideline.
  • Vitamin D and calcium supplements, taken together, have a modest effect on fractures. It is unclear how effective either is if taken alone.