Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid)
Bind to bone, suppress osteoclast activity. There are tablet or injection forms. The absorption of the tablet form is poor but good if taken correctly. Take it on an empty stomach. Open for ½-1 hour after taking it and stay upright. It reduces the risk of osteoporotic fractures and increases BMD. GIS side effect; esophagitis; very rarely osteonecrosis
Estrogen/Hormone therapy
Protective anti-resorptive effect. Increased incidence of breast cancer, coronary heart disease, stroke and venous thromboembolism. It may be considered as a second-line therapy in perimenopausal patients
Estrogen Agonist/Antagonist (raloxifene etc.)
Selective estrogen receptor modulator. It increases BMD and reduces the risk of vertebral fractures. It is less effective than bisphosphonates and estrogen. It reduces the risk of breast cancer. It can be given to those who cannot tolerate first-line agents (bisphosphonate). It has side effects such as thromboembolism and flushing
Calcitonin
It binds to osteoclasts and suppresses resorption. Salmon-sourced ; Beware if you are allergic to salmon. Nasal spray is the most preferred application. It is less effective than other treatments. It helps in reducing the pain associated with a vertebral compression fracture.
Parathyroid Hormone (teriparatide etc.)
Resorption stimulates bone formation more. It is used in those who cannot tolerate bisphosphonates or who develop fractures during its use. It is administered as a daily injection. It is only approved for use up to 24 months.
Danastagramab, a treatment used in selected cases.
Strontium Ranelate (Protos®)
Prevents bone resorption and increases bone formation. It reduces the risk of new vertebral fractures by 41% and reduces the risk of non-vertebral fractures by 15%. 2g sachets/day. Side Effects: Thrombo-embolism, DRESS Syndrome (Drug Rash with Eosinophilia and Systemic Symptoms)
Human lifespan is getting longer: we all want to get older, not get old. Therefore, we wish each other a long and healthy life. Remember, your bones are your most valuable treasure in this process.
