Pharmacologic therapy; For the treatment of osteoporosis in postmenopausal women

Pharmacologic therapy

For the treatment of osteoporosis in postmenopausal women

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1.bisphosphonates 

as first-line therapy (Grade 2B)

We prefer oral bisphosphonates as initial therapy 

because of their efficacy, favorable cost, 

and the availability of long-term safety data.

cf)sit upright for 30 to 60 minutes

cf)contraindications to bisphosphonates 

(achalasia, scleroderma esophagus, esophageal strictures) 

1-1. intravenous bisphosphonate

Zoledronic acid is 

the only intravenous bisphosphonate

-cannot tolerate oral bisphosphonates

-difficulty with dosing requirements,

-an inability to sit upright for 30 to 60 minutes

-relative contraindications to bisphosphonates

1-2.Denosumab 

-cannot tolerate oral bisphosphonates

-difficulty with the dosing requirements 

-impaired renal function.

-intolerant of or unresponsive to any bisphosphonates.

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2.ibandronate

we suggest alendronate or risedronate over oral ibandronate (Grade 2B)

Oral ibandronate may be more convenient for patients, 

but a reduction in hip fracture risk 

has not been established in randomized trials.

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3.raloxifene

-postmenopausal women with osteoporosis (low bone mineral density [T score <-2.5] 

-no fragility fractures

-intolerant of or unresponsive to any bisphosphonates.

-cannot tolerate for any bisphosphonates

-not candidates for any bisphosphonates

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4.Strontium ranelate

 

-cannot tolerate any bisphosphonates

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5.parathyroid hormone (PTH therapy)

-postmenopausal women with severe osteoporosis

-low bone mineral density [T score <-2.5] and 

at least one fragility fracture

-unable to tolerate any of the available bisphosphonates (Grade 2B).

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6.human recombinant PTH therapy 

-after 1 year of bisphosphonate therapy

-stop bisphosphonate therapy

-switching to human recombinant PTH therapy (Grade 2B). 

-unable to tolerate bisphosphonates

-relative contraindications to bisphosphonates

-relative contraindications to selective estrogen receptor modulators (SERMs) (thrombosis, hot flashes)

-other osteoporosis therapies fail (fracture with loss of bone mineral density [BMD] in spite of compliance with therapy).