Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults

Publication Date: January 3, 2023

Last Updated: May 15, 2023

Objective

This patient summary discusses key recommendations from the American College of Physicians for Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults. This patient summary is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Osteoporosis is one of several bone conditions that decreases bone mass.
A decrease in bone mass can increase the chances that a bone will break.
Osteoporosis most often occurs in postmenopausal women, since estrogen is a major promotor of bone growth. However, osteoporosis can occur in both men and women of any age.
The first symptom of osteoporposis is usually a broken bone.
In both men and women, it is necessary to rule out secondary causes of low bone mass before starting any medical treatment.
Other (secondary) causes of low bone mass are type 1 diabetes, improper nutrition, metabolic disorders, kidney or liver disease and medications like cortisone.
This patient summary focuses on the pharmacological (medications) treatment of low bone mass.to prevent fractures (broken bones).

Risk Assessment

The treatment decisions for osteoporosis are usually based on your risk level for bone fractures. The levels most commonly used are low, medium, high, or very high.
There are many different factors that determine your risk level.
Some of these factores can be changed by you, and some others cannot be.

Factors that can be changed by you:

The medications you are taking
Your calcium and vitamin D intake
Whether you smoke
Whether you drink, and how much
Exercise and lifestyle choices
Your eating habits

Factors that cannot be changed by you:

Your gender - women are at higher risk for fractures
Your age - the older you are, the higher your risk for fractures
Your ethnicity - caucasian and asian individuals on average have greater fracture risk
Your bone size/density
Family history and genetics

Treatment

Bisphosphonates are usally the initial medication used to reduce the possibility of bone fractures in both men and women with primary osteoporosis. (, )

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In some men and women who are unable to use bisphosphonates, the medication denosumab (PROLIA) may be prescribed. (, )

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In women who are at very high risk for fractures, the medications romosozumab (EVENITY) or teriparatide (FORTEO) may be prescribed. (, )

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For women over the age of 65, the decision to use bisphosphonate medications should be made on a case by case basis. If you are a woman over the age of 65, talk to your healthcare provider to determine whether bisphosphonates are right for you. (, )

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Source Citation

Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, Shamliyan T, Cooney TG; Clinical Guidelines Committee of the American College of Physicians; Cross JT Jr, Fitterman N, Lin JS, Maroto M, Obley AJ, Tice JA, Tufte JE. Pharmacologic Treatment of Primary Osteoporosis or Low Bone Mass to Prevent Fractures in Adults: A Living Clinical Guideline From the American College of Physicians. Ann Intern Med. 2023 Feb;176(2):224-238. doi: 10.7326/M22-1034. Epub 2023 Jan 3. PMID: 36592456.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.