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

Did You Know?

  • Despite the prevalence of osteoporosis and fractures in LTC, and the availability of therapies, many individuals are not being treated after a fracture or if they are at high risk for fractures.
  • 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.


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

First-line therapy is 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 (particularly on vertebral fracture) probably outweigh the harms of treatment, the cost of therapy restricts its access, and there may be a higher burden due to daily injections.

Learn more about recommended administration and contraindications.

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



Renal Function in Elderly Long-Term Care Home Residents
Intensity of Warfarin Therapy and Use of Interacting Medications in Long-Term Care
Osteoporosis management among residents living in long-term care
STOPP/START criteria for potentially inappropriate prescribing in older people: V2
Safe Administration OP Therapy

Video Resources

Treating Osteoporosis – Dr. Prasad

Meeting the Challenge of Osteoporosis