First prescriptions for osteoporosis
1. Pre-consultation
Communication issues to bear in mind
Reassurance is key for anyone who has received a first prescription for an OP medication. Many patients will be concerned about the impact the condition will have on their everyday life. However, not everyone with OP goes on to sustain a fracture, and someone who does is not necessarily going to experience ongoing problems. Pain and other issues are not a given, but if they do occur, there are ways in which individuals can manage in order to live their lives as fully as possible.
Management recommendations for OP are based on the National Osteoporosis Guideline Group clinical guidance, although there are some slight variations in the Scottish Intercollegiate Guidelines Network guidance (SIGN 142).
Management recommendations for OP
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 tibilone 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 (with some licensing restrictions). Zoledronate, denosumab, teriparatide and strontium ranelate are alternatives.
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