Medication Treatment
Did you know?
Osteoporosis leads to fragility fractures. These are broken bones that happen from a minor injury but have major consequences such as pain, disability and sometimes death. Osteoporosis Canada supports the use of medications that have been proven, in clinical trials, to significantly reduce a person’s risk of fracture. The primary goal of treatment is to reduce the risk of fracture.
For those living with osteoporosis, there are a variety of treatment options available. Everyone is different – some people respond better to one drug than another, while some experience side effects that others don’t. You may need to explore several treatment options before you find one that works for you.
It’s important to speak to your doctor to assess the benefits and risks of each treatment and determine which is best for you.
Fewer than 20% of fracture patients in Canada currently undergo diagnosis or adequate treatment for osteoporosis.
Osteoporosis Treatments
Specific drug treatments to treat osteoporosis include:
Bisphosphonates
Bisphosphonates are the most common family of drugs used to treat osteoporosis. They are part of the group of osteoporosis medications known as anti-resorptives. There are three bisphosphonates currently approved for use in Canada: alendronate (Fosamax ®), risedronate (Actonel ®) and zoledronic acid (Aclasta®). Also available are: Actonel DR™(DR = delayed release), Fosavance® (alendronate with vitamin D) and several generic versions.
Denosumab
Denosumab is a type of osteoporosis treatment called a human monoclonal antibody that inhibits the development and activation of osteoclasts (the cells that eat away bone). It is an anti-resorptive like the bisphosphonates (see above). It is very important not to miss, delay or stop denosumab injections, unless directed by your doctor. Missing or delaying a denosumab injection can lead to rapid bone loss and risk of spine fractures. If stopping denosumab, it is recommended to transition to a bisphosphonate to reduce the risk of rapid bone loss and spine fractures.
Parathyroid Hormone Analogues (PTH)
Parathyroid hormone analogues belong to a class of osteoporosis medications which can promote bone growth (also known as bone formation or anabolic agents). In Canada, there are currently three commercially available products in this class. The generic name of these medications is teriparatide.
Romosozumab
Romosozumab is a new class of osteoporosis treatment, a sclerostin inhibitor that both increases bone formation and decreases bone resorption. Romosozumab (Evenity™) is the first treatment approved by Health Canada in this class.
Menopause Hormone Therapy (MHT)
Menopause Hormone Therapy (MHT), with estrogen/progesterone, is commonly used to relieve the symptoms of menopause. Because estrogen plays such an important role in maintaining bone, MHT is another option to consider to treat osteoporosis if you are also seeking relief from symptoms of menopause.
Selective Estrogen Receptor Modulators (SERMs)
Raloxifene (Evista®) is from a family of drugs called SERMs (Selective Estrogen Receptor Modulators).
Biosimilars
A biosimilar medication is a biologic drug that is highly similar (but not identical) to an existing biologic medication and works the same way in the body. It goes through very strict testing to prove it is just as safe and effective. A biosimilar medication is not a generic medication which is identical to the originator molecule.
Provincial and Territorial Drug Coverage for Osteoporosis Treatment
Provincial and Territorial drug plans may cover certain treatments only for certain patients.
In addition to taking an osteoporosis treatment, individuals should aim to get their recommended daily allowance of bone building nutrients including calcium, vitamin D, protein, vitamin K and magnesium.