What are the current guidelines for pharmacological treatment options in patients diagnosed with osteoporosis?

Pharmacological treatment options for patients diagnosed with osteoporosis according to current UK guidelines include:

• Offer oral bisphosphonates as first-line treatment if bone-sparing treatment is indicated, specifically alendronate 70 mg once weekly or risedronate 35 mg once weekly. If these are unsuitable or not tolerated, ibandronate 150 mg once monthly is an alternative. Risedronate is the only oral bisphosphonate licensed for use in men, while all are licensed for postmenopausal women ¹.
• If oral bisphosphonates are contraindicated or not tolerated, refer to a specialist for consideration of alternative treatments such as zoledronic acid, strontium ranelate, raloxifene, denosumab, or teriparatide ¹.
• Calcium and vitamin D supplementation should be prescribed if dietary calcium intake is inadequate. For adequate calcium intake (≥700 mg/day), prescribe 10 micrograms (400 IU) vitamin D alone for those with limited sunlight exposure. For inadequate calcium intake, prescribe vitamin D with at least 1000 mg calcium daily; elderly housebound or nursing home residents should receive 20 micrograms (800 IU) vitamin D with calcium ¹.
• Consider hormone replacement therapy (HRT) for younger postmenopausal women (generally ≤60 years) with osteoporosis and menopausal symptoms, as it reduces vertebral, non-vertebral, and hip fracture risk. HRT is not routinely recommended for older women due to an unfavorable risk/benefit balance ¹.
• For patients on oral corticosteroids, continue bisphosphonates and/or calcium and vitamin D during corticosteroid treatment and reassess fracture risk after cessation. Long-term corticosteroid users should maintain bone protection ¹.
• After starting treatment, monitor tolerance at 12-16 weeks focusing on adverse effects such as upper gastrointestinal symptoms and signs of atypical fractures. Adherence should be checked after 12 months ¹.
• Reassess the need for continuing bisphosphonate treatment after 5 years in most patients; continue for at least 10 years in those at high risk (age ≥70 at start, previous hip/vertebral fracture, or new fractures during treatment). Decisions to pause or continue treatment should be guided by DXA T-scores and clinical judgement ¹.