Osteoporosis LTC Recommendations

6. Pharmacological Therapy

Pharmacological interventions for those at high risk of fracture are most important. There are a number of effective therapies available to reduce the incidence of fractures in frail older adults.

Did You Know?

  • Despite availability of therapies, many individuals are not being treated after fracture
  • Men are less likely to be treated
  • Therapeutic options can reduce the number of new vertebral compression fractures by 40-60% in individuals with a fracture
  • Despite the prevalence of osteoporosis and fractures in LTC, the use of osteoporosis medications is infrequent

What are the recommendations for the use of pharmacological therapy in long-term care?

First line therapy recommended for individuals at high riskFor individuals at high risk and difficulty swallowing medications
Alendronate70 mg weeklyDenosumab60 mg subcut twice yearly
Risedronate35 mg weekly or 150 mg monthlyZoledronic acid5 mg IV yearly

Learn more about recommended administration and contraindications.

First line therapy suggested* for individuals at high risk
Teriparatide20 mcg subcut daily

*Although the benefits of teriparatide (in particular on vertebral fracture) probably outweigh harms of treatment, the cost of therapy restricts its access, and there may be a higher burden due to daily injections

For individuals at high risk we recommend NOT to use:

  • Etidronate
    There is moderate quality evidence for little to no reduction in fractures (in particular hip fractures) with etidronate. The cost is also high given the lack of important benefits. 
  • Raloxifene
    The harms of raloxifene (e.g. venous thromboembolism and musculoskeletal events – arthralgia, myalgia) probably outweigh the probable reduction in vertebral fractures and small reductions in hip and non-vertebral fractures.

Visit the CMAJ Group website for more information about these medications.


Learn about strategies to prevent falls and fractures.

A summary of recent literature on renal function in the elderly in LTC.