Osteoporosis Drug Options

Bisphosphonates

Consider drug discontinuation after 5 years in low-risk patients

Small risk of atypical femoral shaft fractures; osteonecrosis of the jaw

Alendronate (Fosamax)

Prevention

Hip, vertebral, nonvertebral

5 mg per day or 35 mg per week, oral

$53

Mild upper gastrointestinal events, esophageal ulcerations, perforations, bleeding events, muscular and joint pains

Contraindications: abnormalities of the esophagus; inability to stand or sit upright for at least 30 minutes; hypersensitivity to any product component; increased risk of aspiration or dysphagia

Hip: 91 (2 to 5 years)

Treatment

Hip, vertebral, nonvertebral

10 mg per day or 70 mg per week, oral

$107

Alendronate/cholecalciferol (Fosamax Plus D)

Treatment

Hip, vertebral, nonvertebral

70 mg plus 2,800 IU or 5,600 IU per week, oral

$140

Same as alendronate

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Ibandronate (Boniva)

Prevention and treatment

Vertebral only

150 mg monthly or 2.5 mg per day, oral

$153

Same as alendronate

Spine: 20 (3 years)

Treatment

Vertebral only

3 mg every 3 months, IV

$159 (one dose = $477)

Same as alendronate

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Risedronate (Actonel)

Prevention and treatment

Hip, vertebral, nonvertebral

5 mg per day

or

35 mg per week

or

75 mg in two consecutive days per month

or

150 mg per month, oral

$199

Same as alendronate

Hip: 77 (3 years)

Risedronate, delayed release (Atelvia)

Treatment

Hip, vertebral, nonvertebral

35 mg per week, oral

$168

Same as alendronate

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Risedronate with calcium

Prevention and treatment

Hip, vertebral, nonvertebral

35 mg per week (day 1) plus 1,250 mg calcium per day (days 2 to 7 each week), oral

$216

Same as alendronate

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Zoledronic acid (Reclast)

Prevention

Hip, vertebral, nonvertebral

5 mg every 2 years, IV

$45 (one dose = $1,083)

Muscular and joint pains.

Contraindications: hypocalcemia creatinine clearance < 35 mL per minute per 1.73 m2 (0.58 mL per second per m2) and acute renal impairment; hypersensitivity to zoledronic acid or any components of this product

Hip: 91 (3 years)

Spine: 30 (2 years; from 1 study of men)

Treatment

Hip, vertebral, nonvertebral

5 mg per year, IV

$90 (one dose = $1,083)

Raloxifene (Evista)

Prevention and treatment

Vertebral only

60 mg per day, oral

$198

Pulmonary embolism, thromboembolic events

Contraindications: venous thromboembolism; pregnancy, women who may become pregnant, and breastfeeding mothers

Spine: 29 (3 years)

Teriparatide (Forteo)

Treatment (high risk*)

Vertebral, nonvertebral

20 mcg per day for up to 2 years, subcutaneous

$1,545

Arthralgia, pain, nausea, transient orthostatic hypotension, hypercalcemia, hyperuricemia

Contraindications: hypersensitivity to teriparatide or to any of its components; reactions have included angioedema and anaphylaxis

Spine: 11 (1.5 years)

Denosumab (Prolia)

Treatment (high risk*)

Hip, vertebral, nonvertebral

60 mg every 6 months, subcutaneous

$146 (one dose = $881)

Muscular and joint pains; small risk of osteonecrosis of the jaw (especially older women with poor dental hygiene or cancer) Contraindications: hypocalcemia; pregnancy

Spine: 21 (3 years)