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.
Resources
Video Resources
Treating Osteoporosis – Dr. Prasad
