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 risk||For individuals at high risk and difficulty swallowing medications|
|Alendronate||70 mg weekly||Denosumab||60 mg subcut twice yearly|
|Risedronate||35 mg weekly or 150 mg monthly||Zoledronic acid||5 mg IV yearly|
|First line therapy suggested* for individuals at high risk|
|Teriparatide||20 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:
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.
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.