Osteoporosis Medications (Anti-Fracture Options)
Dr. David Hanley Osteoporosis Centre
| Osteoporosis Medications | Description | Mechanism | Duration | Access |
|---|---|---|---|---|
| Raloxifene (Evista®) – Oral Daily | Maintains bone mass and hardens the bone I have. | Long term continuous | Covered by Alberta Seniors Blue Cross. | |
| Alendronate (Fosamax®) – Oral Once Weekly or per Month | Maintains bone mass and hardens the bone I have. | Usually 5 years followed by 3 to 5 years 'drug holiday'. | No special requirements, covered by Alberta Seniors Blue Cross. | |
| Risedronate (Actonel®) – Oral Once Weekly or per Month | Maintains bone mass and hardens the bone I have. | Usually 5 years followed by 3 to 5 years 'drug holiday'. | No special requirements, covered by Alberta Seniors Blue Cross. | |
| Zoledronic Acid – Injection Intravenous Once Yearly | Maintains bone mass and hardens the bone I have. | Usually 3 years followed by 3 to 5 years 'drug holiday'. | Highly restricted coverage by Alberta Seniors Blue Cross. Enrollment forms needed | |
| Denosumab (Prolia®) – Injection Under the Skin Every 6 Months | Maintains bone mass and hardens the bone I have. | Undefined. Talk to your doctor before delaying a dose or stopping this medication | Highly restricted coverage by Alberta Seniors Blue Cross. | |
| Teriparatide (Forteo®, Teva-Teriparatide) – Injection Under the Skin Daily | Increases new bone formation. | 2 years, followed by one of the above options. | Not covered by Alberta Seniors Blue Cross, other insurers vary. Enrollment forms needed | |
| Romosozumab (EVENITY®) – Injections under the skin (2) every month | Increases new bone formation | 1 year, followed by one of the above options. | Not covered by Alberta Seniors Blue Cross, other insurers vary. Enrollment forms needed |
Osteonecrosis of the Jaw (ONJ)
What is it?
- An area of exposed bone in the jaw that does not heal for 8 weeks or more
- May or may not be painful
- Most cases have occurred in people who are receiving bisphosphonate medications for cancer in much higher doses than we use for osteoporosis
- It has been associated with bisphosphonate medications and denosumab (Prolia®)
How Frequently does it Occur?
- The risk of developing this condition is estimated to be less than 1 in 10,000 for a five-year treatment course
- The risk may increase with longer treatment duration and is likely to decrease when the medication is stopped
What are the Risk Factors?
- Smoking, heavy alcohol intake
- Invasive dental procedures (this does not include regular cleanings, fillings or root canals)
What can I do to Prevent it?
- Maintain good oral hygiene, go for regular dental check-ups
- Let your doctor know if you are having major dental surgery. They may decide to stop the medication temporarily after the surgery, until the wound has healed
- Stop smoking
Atypical Femoral Fractures (AFF)
What are They?
- Fractures of the thigh bone (femur)
- Can occur without falling or trauma
- May occur in both legs
- They have been associated with bisphosphonate medications and denosumab (Prolia®)
What Symptoms do They Cause?
Some people develop a dull aching pain in one or both thighs before the femur bone fractures. You should inform your doctor if this happens.
How Frequently do They Happen?
- The risk of having one of these fractures is estimated to be between 1 in 1000 and 1 in 10,000 for a five-year treatment course
- For every one of these fractures that occurs because of osteoporosis medications, approximately 100 hip fractures are prevented
- The risk may increase with longer treatment duration and is likely to decrease when the medication is stopped
What are the Risk Factors?
The risk seems to be higher in people of Asian ethnicity, people who are taking steroid medications (such as prednisone), and people with rheumatoid arthritis.