Osteoporosis therapy contains bisphosphonares and anabolic agents. Lifestyle measures should be corrected. Initiating therapy with bisphosphonates due to efficacy, favorable cost, and long-term safety is considered.

1. Osteoporosis Therapy
Vinod Kumar Mugada
Associate professor
Department of pharmacy practice
Vignan Institute of Pharmaceutical
Technology

3. What is T-Score?
• Individual’s bone mineral density is compared with
healthy adults BMD
• -1 or above is normal; -1.0 to -2.5 low bone density;
-2.5 or below- osteoporosis
• Imp tool in diagnosis of osteoporosis and
determining the risk of fracture

4. What is BMD
•Measure of amount of calcium and
phosphorus in a specific area of
bone
•Key indicator of bone strength
•Measured using DEXA scan

5. Lifestyle measures
• Adequate calcium and Vitamin-D
• Exercise
• Smoking cessation
• Counseling on fall prevention
• Avoiding heavy alcohol use

6. Calcium and Vitamin-D
• Calcium is ESSENTIAL mineral for strong bones
• Calcium is the primary mineral among the complex matrix of
proteins and minerals
• Hardness and strength of bones is due to calcium
• Low dietary calcium Calcium from bone enters the blood
stream decreased BMD Osteoporosis (overtime)
• Vitamin D is necessary for the body to absorb and utilize calcium
effectively, so it is important to maintain adequate levels of both
nutrients

7. Calcium and Vitamin-D
• In general, 1200 mg of Calcium + 800 IU of
vitamin-D daily are advised
• If dietary calcium intake is adequate, then the
supplementation is unnecessary
• However, many patients require vitamin D
supplementation as it is difficult to achieve goals
with diet alone

8. Smoking and osteoporosis
• Reduced calcium absorption/impaired bone
formation/increased bone resorption = decreased
BMD, particularly in hip and spine
• Lower estrogen in women and testosterone in
men= dysregulation of bone growth and
maintenance
• Impairs absorption of calcium and vitamin D levels
also

9. Alcohol and osteoporosis
• Interferes with body’s ability to absorb and utilize nutrients such
as calcium, magnesium, and vitamin-D
• Affects hormone levels
• Excessive alcohol consumption can lead to CLD and impairs the
ability to activate vitamin-D
• Increases the risk of falls and fractures by impairing balance and
coordination

10. Physical activity and osteoporosis
• Weight-bearing exercises, such as walking, jogging, hiking, dancing,
and resistance training, help build bone mass and density by placing
stress on bones, which stimulates the bone-building cells called
osteoblasts.
• Exercise also helps improve balance and coordination, which can
reduce the risk of falls and fractures.
• It is recommended to engage in weight-bearing exercise for at least
30 minutes a day, at least three to four times a week.

11. Patient selection for therapy
• Postmenopausal women with established osteoporosis or
fragility fracture
• T-scores between -1.0 to -2.5
• Presence of 4 or 5 risk factors such as age,
corticosteroid therapy, family history, current cigarette
smoking, excessive alcohol consumption, rheumatoid
arthritis, and secondary osteoporosis

12. Most women
• Initial treatment for postmenopausal women ORAL
BISPHOSPHONATES
• Preferred for their Efficacy, Favorable COST, long–
term safety data
• ALENDRONATE/ RISEDRONATE- initial choice of
Bisphosphonates

13. Severe Osteoporosis
• Initial treatment with an ANABOLIC agent
• Considering cost, S/C route of administration, and long-term
safety sometimes BISPHOSPHONATES are preferred
• If anabolic therapy- TERIPARATIDE/ ABALOPARATIDE
• ROMOSOZUMAB is another alternative
• The above MAB induces greater BMD response than anabolic
agents.
• However, treatment is indicated for only one year due to long-
term safety concerns and limited clinical experience

14. Severe Osteoporosis
•Anabolic therapy is limited to maximum of
one to two years
•Its treatment is followed with anti-resorptive
agents such as bisphosphonates to preserve
the gains in BMD achieved with an anabolic
agent

15. Very High Risk of fracture
• Very high risk: T-score ≤ -3.0/ -2.5+ fragility
fracture, severe or multiple vertebral
fractures- ANABOLIC AGENT
• DENOSUMAB is an alternative

16. High Risk of fracture
• High risk: Osteoporosis by BMD/T-score > -2.5+ fragility
fracture, single vertebral fractures- DENOSUMAB
• If unable to tolerate oral or IV bisphosphonates,
ANABOLIC agents are preferred
• Caution- Increased risk of vertebral fracture after
discontinuation of denosumab