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Bisphosphonates are commonly used to treat osteoporosis, but several non-bisphosphonate osteoporosis medications can help reduce fracture risk. Pharmacists should understand the mechanisms, adverse effects, and clinical pearls associated with these alternatives. On this podcast episode, I will cover four of the most commonly used “non-bisphosphonate” osteoporosis medications.
Denosumab (Prolia) is a RANKL inhibitor that decreases osteoclast activity and bone resorption. It is administered subcutaneously every six months.
Teriparatide (Forteo) and abaloparatide (Tymlos) stimulate bone formation through the parathyroid hormone pathway. These medications may be appropriate for patients at very high fracture risk.
Raloxifene (Evista) is a selective estrogen receptor modulator (SERM) that reduces bone resorption. It primarily reduces vertebral fracture risk and may lower the risk of estrogen receptor-positive breast cancer. Important adverse effects include hot flashes and an increased risk of venous thromboembolism.
Calcitonin (Miacalcin) inhibits osteoclast-mediated bone resorption. However, its effectiveness for fracture prevention is limited, making it a less-preferred option for long-term osteoporosis treatment.
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