Treatment of Osteoporosis

Treatment of 


Who should be considered for treatment

Postmenopausal women

Postmenopausal women and men aged 50 years and above who present with the following should be considered for treatment1

A hip or vertebral fracture (clinically apparent or found on vertebral imaging) because it was shown that the patients with spine and hip fractures had reduced fracture risk with pharmacologic therapy, irrespective of the T score.

Determination of fractures when the T-score ≤−2.5 at the femoral neck, total hip, or lumbar spine

Low bone mass (T-score between −1.0 and −2.5 at the femoral neck or lumbar spine) and

10-year probability of a hip fracture ≥3% or a 10-year probability of a major osteoporosis-related fracture ≥20%

T score levels 2

T Scores & WHO diagnostic criteria for Osteoporosis




-1.0 and higher


-1.0 to -2.5


-2.5 and lower

Severe osteoporosis

-2.5 and lower with one  or more fragility fractures

*Reference values vary by geographical location

WHO = World Health Organization

Note: T-score is a comparison of a person’s bone density with that of a healthy 30-year-old of the same sex. A T-score between −1 and −2.5 indicates low bone mass, although not low enough to be diagnosed with osteoporosis. A T-score of −2.5 or lower indicates that you have osteoporosis. The greater the negative number, the more severe the osteoporosis

Pharmacological Therapy

The main goals of therapy in osteoporotic patients are as follows:

Pharmacological Therapy

To prevent fractures by improving bone strength and reducing the risk of falling and injury

Pharmacological Therapy

To relieve symptoms of fractures and skeletal deformity

Pharmacological Therapy

To maintain normal physical function

Pharmacological Therapy

Medications to treat osteoporosis are categorized as either antiresorptive (i.e. bisphosphonates, estrogen agonist/ antagonists [EAAs], estrogens, calcitonin, and denosumab) or anabolic (i.e., teriparatide).

As per AACE/ACE* guidelines, first-line treatment for most PMO (Post-Menopausal Osteoporosis) patients at high risk of fracture includes Risedronate, Alendronate, Zoledronic acid, and Denosumab

For those who cannot use oral therapy and are at high risk of fracture, use of teriparatide, denosumab, or zoledronic acid is recommended.

* AACE/ACE: American Association of Clinical Endocrinologists and American College of Endocrinology

Non-Pharmacological  Therapy

Adequate calcium and vitamin D intake (Calcium 1000mg for men & 1200mg for women) Vitamin D-600 IU for men & 800 IU for women)

References –

  1. Eur J Rheumatol. 2017 Mar; 4(1): 46–56
  2. P T. 2018 Feb; 43(2): 92–104
  3. Osteoporosis: A Review of Treatment Options 2018 Feb; 43(2): 92–104