Common Drug Treatments for Osteoporosis

Abstract
The most commonly used initial treatments for prevention of fracture, alendronate (a bisphosphonate) and denosumab, inhibit bone resorption. Bisphosphonates bind to the surface of bone and their effects gradually wane after discontinuation. Denosumab is a more potent antiresorptive that inhibits the development and action of bone resorbing osteoclasts. Bone resorption rebounds with bone loss and increased risk of vertebral fracture when it is discontinued after ≥ 3 years. They reduce the risk of all types of fractures. Bone forming drugs, such as romosozumab, are more effective and are warranted in patients at very high risk by a bone density (BMD) T-score < -3 or a recent fracture. Romosozumab is given for 12 months and must be followed by treatment with an anti-resorptive to maintain the BMD.

Learning Objectives
1). Comparative efficacy of these 3 common drugs for osteoporosis.
2). The adverse effects of those treatments.
3). The different consequences of stopping treatments.