Pharmacotherapy of



Pharmacological Treatment Options for Osteoporosis

Marie Meyer, PharmD Candidate 2007

| |Bisphosphonates |Calcitonin |Hormones |Parathyroid Hormone |Selective Estrogen Receptor Modulator |

|Product |Alendronate (Fosamax) |Salmon Calcitonin |Estradiol (Climara, Estrace, Estraderm, Vivelle) |Teriparatide (Forteo) |Raloxifene (Evista) |

|Availability |Ibandronate (Boniva) |(Miacalcin, Fortical) |Estropipate (Ogen, Ortho-Est) | | |

|Generic (Brand) |Risedronate (Actonel) | |Conjugated Estrogens (Premarin) | | |

| | | |Estradiol & Norethindrone (Activella) | | |

| | | |Ethinyl Estradiol & Norethindrone Acetate (Femhrt)| | |

| | | |Conjugated Estrogens & Medroxyprogesterone | | |

| | | |(Premphase, Prempro) | | |

|Mechanism |Act on osteoclasts & osteoblasts ( |Inhibits osteoclast function |Increases bone mineralization |Stimulates osteoblast function ( |Acts like estrogen at the bone |

|of Action |decrease bone resorption |( decreases bone resorption | |increases bone mass | |

|EFFICACY |prevention and treatment of postmenopausal|Treatment of osteoporosis in |Never for osteoporosis alone, may be indicated for|Treatment of osteoporosis in |prevention and treatment of |

| |+ glucocorticoid induced osteoporosis |women at least 5 years post |treatment of osteoporosis in patients who also |postmenopausal women with high |postmenopausal osteoporosis |

|(Indication/ Use, | |menopause |have symptoms of menopause such as hot flashes |fracture risk | |

|Clinical Data |Alendronate – 3 year 50% ↓ vertebral, hip | | | |3 year 30% ↓ in vertebral, fracture in |

|Support) |& wrist fracture in patients with prior |↑ spine BMD in women |Reduces vertebral, non-vertebral, and hip |18 month 65% ↓ in spine fracture and |patients with prior spine fracture. |

| |vertebral fracture. | |fractures, increases spine and hip BMD in women |53% ↓ in non-spine fractures |3 year 55% ↓ in spine fracture in |

|***note***data in |3 year 48% ↓ vertebral fracture in |may ↓ vertebral fracture | | |patients with no history of prior spine|

|men not available |patients with no history of vertebral | | |↑ spine BMD in men |fracture. |

|for all drugs |fracture. | | |↑ spine & hip BMD in women | |

| |↑ spine & hip BMD in men & women | | | |↑ spine & hip BMD in women |

| |Ibandronate – 3 year 50% ↓ vertebral | | | | |

| |fractures | | |no data on efficacy of therapy > 2 | |

| |↑ spine & hip BMD in women | | |years | |

| | | | | | |

| |Risedronate – 3 year 41-49% ↓ vertebral | | | | |

| |fractures, 36% ↓ non-vertebral & hip | | | | |

| |fractures in patients with prior vertebral| | | | |

| |fracture | | | | |

| |↑ spine & hip BMD in women | | | | |

| |Bisphosphonates |Calcitonin |Hormones |Parathyroid Hormone |Selective Estrogen Receptor Modulator |

|Dosage & |Alendronate |Treatment |Do not use for prevention or treatment of |Treatment |Prevention or Treatment |

|Administra-tion |Post-menopausal women |200 international units (1 |osteoporosis unless patient also requires hormone |20 mcg subcutaneously once daily |60 mg po daily |

| |Prevention: 5mg po daily or 35mg po once |intranasal spray) once daily |therapy for relief of menopausal vasomotor | | |

|(Include renal |weekly | |symptoms and/or vulvovaginal atrophy. | |avoid use in hepatic impairment |

|and/or hepatic |Treatment 10mg po daily or 70mg po once | | | | |

|adjustments) |weekly | |Consider for osteoporosis prevention alone only | | |

| |Men – Treatment 10mg po daily or 70mg po | |after approved non-estrogen treatments have been | | |

| |once weekly | |considered first. | | |

| |Men and women – steroid-induced disease | | | | |

| |5mg po daily or 10mg po daily for estrogen| |Estradiol 0.5 mg daily x 3 weeks, then 1 week off,| | |

| |deficient women | |repeat cycle | | |

| |Do not use in patients with | |Estropipate 0.75 mg daily for 25 days of a 31-day| | |

| |Clcr ................
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