OSTEOPOROSIS
 

• RISK FACTORS FOR OSTEOPOROSIS: include early menopause, family history of osteoporosis, inadequate calcium or Vitamin D intake (eg, alcoholism, anorexia, celiac disease), Asian or Caucasian descent, smoking, amenorrhea, personal history of bone fractures as an adult, history of bone fractures in a parent or sibling, having a small or thin frame, type 1 diabetes, thyroid or renal disease, immobility/inactivity, and some drugs (eg, chronic corticosteroid intake, anticonvulsants, immunosuppressants, antiestrogens).

• PREVENTION OF OSTEOPOROSIS: includes adequate lifetime intake of calcium (preferably from dietary sources) and Vitamin D, weight-bearing exercise, and drug therapy for patients at risk.

a) Recommended calcium intake: Birth–6 months: 400mg/day. 6–12 months: 600mg/day. 1–5 yrs: 800mg/day.
6–10 yrs: 800 to 1200mg/day. 11–24yrs: 1200mg to 1500mg/day. Women 25–50yrs: 1000mg/day.
Pregnant or lactating women: 1200 to 1500mg/day. Postmenopausal women on estrogen replacement therapy: 1000mg/day.
Postmenopausal women not on estrogen replacement therapy: 1500mg/day. Women and men over 65yrs: 1500mg/day.
Up to 2000mg/day appears to be safe in most individuals.

b) Vitamin D recommended intake is 400 IU/daily for women under the age of 25 yrs (usually met through daily exposure to sunlight). If supplements are used, the goal is to attain the minimum RDA without toxicity.

c) HRT: If bone loss is due to estrogen deficiency at menopause, estrogen therapy may be started. Individualize to the lowest effective dose and reevaluate periodically. Administer progestin with estrogens in women with intact uteri. Women who have had a hysterectomy may be given estrogen continuously.
BRAND Component(s) Strength(s) Dose form Dose
BISPHOSPHONATES
ACTONEL Risedronate 5mg, 30mg, 35mg, 75mg, 150mg tab Prevention and Treatment: 5mg once daily or 35mg once weekly or one 75mg tablet taken on 2 consecutive days per month or 150mg once a month1

 
ATELVIA Risedronate 35mg delayed-release tabs

Treatment: 35mg once weekly
BONIVA Ibandronate 150mg tab

Prevention and Treatment: 150mg once monthly1

 
3mg/3mL inj Treatment: 3mg IV once every 3 months
FOSAMAX Alendronate 5mg, 10mg, 35mg, 40mg, 70mg
70mg/75mL		 tab
oral solution

Treatment: 10mg once daily or 70mg once weekly1

 

Prevention: 5mg once daily or 35mg once weekly1

 
FOSAMAX PLUS D Alendronate + Cholecalciferol (Vit. D3) 70mg + 2800 IU
70mg + 5600 IU		 tab Treatment: 70mg/2800IU or 70mg/5600IU once weekly1

 
RECLAST Zoledronic 5mg/100mL inj Treatment: 5mg IV infusion once a year
CALCITONIN
FORTICAL Calcitonin-salmon 200 U/spray nasal spray Treatment: 1 spray in nostril daily; alternate nostrils
MIACALCIN Calcitonin-salmon 200 U/spray nasal spray Treatment: 1 spray in nostril daily; alternate nostrils
200 U/mL injection Treatment: 100 units SC or IM every other day
HORMONE REPLACEMENT THERAPY
ACTIVELLA Estradiol + norethindrone acetate 0.5mg + 0.1mg; 1mg + 0.5mg tab 1 tablet once daily
ALORA Estradiol 0.025mg/day, 0.05mg/day, 0.075mg/day, 0.1mg/day transdermal patch 0.025mg/day patch applied twice weekly; adjust
CLIMARA Estradiol 0.025mg/day, 0.0375mg/day, 0.05mg/day, 0.06mg/day, 0.075mg/day, 0.1mg/day transdermal patch 0.025mg/day patch applied once weekly; adjust
CLIMARA PRO Estradiol + levonorgestrel 0.045mg + 0.015mg/day transdermal patch 1 patch once weekly
ESTRACE Estradiol 0.5mg, 1mg, 2mg tab 0.5mg daily
ESTRADERM Estradiol 0.05mg/day, 0.1mg/day transdermal patch 0.05mg/day patch applied twice weekly
FEMHRT Norethindrone acetate + ethinyl estradiol 0.5mg + 2.5micrograms, 1mg +
5micrograms		 tab 1 tablet once daily
MENOSTAR Estradiol 0.014mg/day transdermal patch 0.014mg/day patch applied once weekly
OGEN Estrone sodium sulfate (as estropipate) 0.625mg, 1.25mg, 2.5mg tab 0.625mg daily
ORTHO-EST Estropipate 0.75mg, 1.5mg tab 0.75mg once daily
PREFEST Estradiol, then estradiol + norgestimate Estradiol 1mg, then estradiol 1mg +
norgestimate 0.09mg		 tab 1 tablet once daily in correct order (ie, 3 tabs of estradiol, then 3 tabs of estradiol + norgestimate, repeat)
PREMARIN Conjugated estrogens 0.3mg, 0.45mg, 0.625mg, 0.9mg, 1.25mg, 2.5mg tab 0.3mg daily; adjust
PREMPHASE Conjugated estrogens, then conjugated estrogens + medroxyprogesterone 0.625mg estrogen, then 0.625mg estrogen + 5mg medroxyprogesterone tab 1 tablet once daily in correct order (ie, 14 tabs of 0.625mg estrogen, then 14 tabs of 0.625mg estrogen + 5mg of medroxyprogesterone; repeat)
PREMPRO Conjugated estrogens + medroxyprogesterone 0.3mg + 1.5mg, 0.45mg + 1.5mg 0.625mg + 2.5mg, 0.625mg + 5mg tab 1 tab once daily
VIVELLE Estradiol 0.05mg/day, 0.1mg/day transdermal patch 0.025mg/day patch applied twice weekly
VIVELLE-DOT Estradiol 0.025mg/day, 0.0375mg/day, 0.05mg/day, 0.075mg/day, 0.1mg/day
OSTEOCLAST INHIBITOR (RANKL INHIBITOR)
PROLIA Denosumab 60mg/mL inj 60mg SC once every 6 months
PARATHYROID HORMONE
FORTEO Teriparatide 250micrograms/mL inj 20 micrograms SC once daily
SELECTIVE ESTROGEN RECEPTOR MODULATORs (SERMs)
EVISTA Raloxifene 60mg tab Prevention and Treatment: 60mg once daily
NOTES

1 See this drug's monograph in this section for important dosing information.

(Rev. 5/2012)