Introduction and management guidelines
Introduction
Osteoporosis (OP) is a progressive condition in which the bones become increasingly weak due to the tissue deteriorating, leading to mineral density decreasing. This renders sufferers at increased risk of fragility fractures, which are broken bones as a result of trauma that would not normally cause such an injury were the bone fully healthy.
Over three million people in the UK are affected by OP, with more than 500,000 individuals receiving hospital treatment for an OP-related fragility fracture every year, so the pharmacy team is likely to encounter many patients with the condition.
Management guidelines
OP management recommendations are based on the National Osteoporosis Guideline Group (NOGG) clinical guidance, although there are some slight variations in the Scottish Intercollegiate Guidelines Network (SIGN) guidance:
Typical guidance
Postmenopausal OP is managed first-line using the oral bisphosphonates alendronate or risedronate, either daily or weekly. SIGN also recommends ibandronate. Parenteral bisphosphonates are alternatives for those who cannot tolerate oral products, or for whom they are unsuitable, with the selective oestrogen receptor modulator (SERM) raloxifene and strontium ranelate additional options if needed.
Younger postmenopausal women who have additional menopausal symptoms may be prescribed hormone replacement therapy. Use is age-restricted due to the risk of adverse effects such as cardiovascular disease and cancer. SIGN also puts forward tibolone for this patient group.
Glucocorticoid-induced OP is also managed using oral alendronate or risedronate, with the annually injected bisphosphonate zoledronic acid, monoclonal antibody denosumab and teriparatide recommended alternatives for those for whom an oral bisphosphonate is inappropriate. If the glucocorticoid treatment is stopped, the bone protection therapy should be reviewed.
OP in men is managed using oral alendronate or risedronate, although there are some licensing restrictions. Zoledronate, denosumab, teriparatide and strontium ranelate are alternatives.