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.
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.