Osteoporosis Drug Treatment Update

Oliveira, Lindomar Guimaráes; Carneiro, Mara Lúcia Rassi Guimaráes; Souza, Márcio Passini Gonćalves de; Souza, Caio Gonćalves de; Moraes, Frederico Barra de; Camargo, Fábio Lopes de

doi:10.1055/s-0040-1714219

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Update Article • Rev. bras. ortop. 56 (5) • Nov-Dec 2021 • https://doi.org/10.1055/s-0040-1714219 copy

Osteoporosis Drug Treatment Update

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The Brazilian population is aging and the prevalence of chronic degenerative diseases,including osteoporosis, is increasing. The diagnosis and treatment of osteoporosis have made significant advances in the last decade. The orthopedist and traumatologist canno longer be detained only in the surgical treatment of osteoporotic fracture. It is extremely important that we know: 1) what risk factors to evaluate, and the Fracture Risk Assesment Tool (FRAX) can be used; 2) which complementary tests should be requested, such asdensitometry, radiography of the spine and pelvis, blood and urine tests, and even bone biopsy; 3) which supplements to use, such ascalcium and magnesium, vitamins D and K; 4) which medications to prescribe, antiresorptives ortrainers, therapeutic windows and adverse events.

Drugs approved by ANVISA for osteoporosis treatment
class	Posology	Fractures reduction	Adverse effects	Approved use
Alendronate	700 mg/week	Vertebral,nonvertebral and hip	Common: esophagitis, musculoskeletal pain; Rare: MON, atypical femur fracture§	Treatment and prevention
Risedronate	Oral: 35 mg/week or 150 mg/month	Vertebral,nonvertebral and hip	Common: esophagitis, musculoskeletal pain;Rare: MON, atypical femur fracture§	Treatment and prevention
Ibandronate	Oral: 150 mg/monthIntravenous: 3 mg/each 3 months	Vertebral	Common: intravenous local reaction,esophagitis, musculoskeletal pain;Rare: MON, atypical femur fracture§	Treatment and prevention
Zoledronic acid	Intravenous: 5 mg/year	Vertebral,nonvertebral and hip	Common: most frequent answer,first dose flu-like symptomsÆ;Rare: MON, atypical femur fracture§	Treatment and prevention
Biologic:denosumab	Subcutaneous:60 mg/semester	Vertebral,nonvertebral and hip	Common: cellulitis or skin reactions;Rare: MON, atypical femur fracture§	Treatment
Anabolic:teriparatide	Subcutaneous:20 µg/day	Vertebral,nonvertebral and hip	Common: nausea, cramps. Hypercalcemia,osteosarcome not confirmed	Treatment
Salmon calcitonine	Intranasal: 200 IU/day	Vertebral	Nasal congestion	Treatment
SERM: raloxifen	Oral: 60 mg/day	Vertebral	Deep vein thrombosis, rubor,cramps, MMII, nausea	Treatment and prevention

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Frederico Barra de Moraes, Department of Orthopedics and Traumatology, Federal University of Goiás, Rua Teresina, 30, apto 1202 - Edf. Spazio Gran Ville, Goiânia, GO 74815715, Brazil (email: frederico_barra@yahoo.com.br).