Comparison: Osteoporosis Medications

 

• All numbers needed to treat (NNT) are in comparison to placebo. These medications haven’t been directly compared

Based on Study

• study was to perform a head-to-head comparison of efficacy and safety profile between 60 mg denosumab (Den) subcutaneously (SC) per 6 months (Q6M) and 70 mg alendronate (Aln) orally per week (QW) for postmenopausal women with low bone mineral density
• The overall rates of AEs and SAEs were balanced between both groups
• 60 mg Den SC Q6M therapy might be more effective for increasing the bone mass of postmenopausal women than the 70 mg Aln oral QW therapy. 
• However the analysis of the relevant clinical outcome demonstrated inconclusive benefits of denosumab over alendronate, its safety profile was not fully clarified either. 
• At present because of its relatively high price, denosumab could not completely replace alendronate for postmenopausal women.

Other Considerations:

• Ensure all patients get adequate calcium and vitamin D. 
• Consider estrogen therapy for prematurely menopausal women less than 50 years old for osteoporosis prevention.Otherwise, estrogen therapy is not indicated solely for prevention of osteoporosis.
• Treating 10,000 women 50 to 79 years of age with estrogen/progestin for one year prevents six spine and six hip fractures. However, there will be eight more cases of breast cancer, nine more strokes, and 21 more thromboembolic events.
• For patients with low fracture risk, adequate calcium and vitamin D, and estrogen if appropriate, may be all that is needed for osteoporosis prevention.

References:

1. PL Detail-Document, Comparison of Medications for Osteoporosis. Pharmacist’s Letter/Prescriber’s Letter. July 2012.
2. http://www.uspharmacist.com/content/c/30060/
3. http://www.medscape.com/viewarticle/760954_4