Guidelines for the Pharmacotherapy of osteoporosis

NOFSA (National Osteoporosis Federation of South Africa ) recommendations on the choice of a pharmacological agent in the treatment of osteoporosis:

a. We acknowledge the fact that, given the heterogeneity of the osteoporosis syndrome and the lack of significant head-to-head comparative studies, no ideal drug scenario for management can be recommended.

b. Drug therapy must be individualised, taking due cognisance of the disease profile (particularly the severity of bone loss and skeletal sites involved), the patient profile (age, general health, concomitant disease, clinical setting), and the available resources and personal preferences.

The Hows and Whys of Osteoporosis Medications

 
CLASS AND DRUGBRAND NAMEFORMFREQUENCYGENDER

Antiresorptive Agents 

Bisphosphonates

AlendronateFosamax®, Fosamax Plus D™Oral (tablet, solution)Daily/WeeklyWomen & Men
AlendronateBinosto®Oral (effervescent tablet)WeeklyWomen & Men
IbandronateBoniva®Oral (tablet)MonthlyWomen
IbandronateBoniva®Intravenous (IV) injectionEvery 3 monthsWomen
RisedronateActonel®Oral (tablet)Daily/Weekly/Twice Monthly/MonthlyWomen & Men
RisedronateAtelvia™Oral (tablet)WeeklyWomen
Zoledronic AcidReclast®Intravenous (IV) infusionOne Time per Year/Once every two yearsWomen & Men

 

RANK ligand (RANKL) inhibitor

 
DenosumabProlia™InjectionEvery 6 MonthsWomen & Men

 

Calcitonin

CalcitoninFortical®, Miacalcin®Nasal sprayDailyWomen
CalcitoninMiacalcin®InjectionVariesWomen

 

Estrogen* (Hormone Therapy)

EstrogenMultiple BrandsOral (tablet)DailyWomen
EstrogenMultiple BrandsTransdermal (skin patch)Twice Weekly/WeeklyWomen

Estrogen Agonists/Antagonists
also called selective estrogen receptor modulators (SERMs)
RaloxifeneEvista®Oral (tablet)DailyWomen

 

Tissue Specific Estrogen Complex (TSEC)

Estrogen/BazodoxifeneDuavee®Oral (tablet)DailyWomen

 

Anabolic Agents

Sclerostin Inhibitor

Romosozumab-aqqgEvenityInjection2 injections once monthly for 12 monthsWomen

Parathyroid Hormone (PTH) Analog

TeriparatideForteo®InjectionDailyWomen & Men

Parathyroid Hormone-Related Protein (PTHrp) Analog

 
AbaloparatideTymlosInjectionDailyWomen
*Estrogen is also available in other preparations including a vaginal ring, cream, by injection and as an oral tablet taken sublingually (under the tongue). The vaginal preparations do not provide significant bone protection.

Osteoporosis Medication and Medication Guidelines (nof.org)

Reference:
JEMDSA 145 2017; 22(1) (Supplement 1)

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