After covering an introduction to fragility fractures and nonpharmacologic treatment options , we will cover pharmacologic management options for when the provider deems this to be appropriate.
After covering an introduction to fragility fractures and nonpharmacologic treatment options , we will cover pharmacologic management options for when the provider deems this to be appropriate. Treatment is usually initiated after any hip or vertebral fractures, T-score of less than 2.5 at the femoral neck, total hip or lumbar spine by DXA scan, post-menopausal women or men age 50 or older with osteopenia (T-score -1.0 and -2.5) at the femoral neck, total hip or lumbar spine by DZA and a 10 year hip fracture probability of greater than 3% or a 10 year major osteoporosis-related fracture probability of greater than 20% based on FRAX score. The goal with treatment aims to increase bone mass and strength by inhibiting bone resorption or promoting bone formation.
Management and choice of agent is dependent on many factors and each case should be individualized depending on past medical history and toleration of agents.The most common class of agents used are oral bisphosphonates. These have been shown to be efficacious and are typically affordable. There is more long-term safety data for these compounds also.
Most providers view these as first line pharmacologic therapy. Specifically, they bind to hydroxyapatite and are absorbed by bone, which inhibits osteoclastic bone resorption via several modalities: cytotoxic or metabolic injury of mature osteoclasts, inhibition of osteoclast attachment to bone, inhibition of osteoclast differentiation or recruitment, and interference with osteoclast structural features necessary for bone resorption. There are two subclasses of bisphosphonates, with the most common being nitrogen containing bisphosphonates.
These include alendronate, ibandronate, pamidronate, risedronate and zoledronate. The non-nitrogen containing bisphosphonates include tiludronate, clodronate and etidronate. There are many studies showing reduced risk of spine and hip fractures (3-11).
Before initiating therapy, it is important for the provider to screen for and possibly treat certain comorbid conditions including hypocalcemia, vitamin D deficiency and renal impairment. These are typically evaluated by laboratory studies. Bisphosphonates should be avoided in patients with creatinine clearance less than 30.
If you are experiencing symptoms that may be related to fragility fractures: pharmacologic treatment, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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