Pharmacologic Agents for Treatment of Osteoporosis
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1 SCAN Drugs Medication Status Biphosphonates alendronate tabs 1 1 Pharmacologic Agents for Treatment of Osteoporosis GIO* prevention for men: 5mg PO QD GIO prevention: 5mg PO QD for women receiving estrogen and 10mg PO QD in women not receiving estrogen Abdominal pain, esophagitis, bone pain, muscle pain, nausea alendronate oral soln 2 2 risedronate 3 [ST] 3 [ST] ibandronate inj 2 ibandronate oral Osteoporosis treatment in men: 10mg PO QD or 70mg PO QW (every week) PMO* prevention: 35 mg PO QW or 5mg PO QD PMO treatment: 70mg PO QW or 10mg PO QD GIO (men and women): 5mg PO QD Osteoporosis treatment in men: 35mg PO QW PMO prevention & treatment: 5mg PO QD or 35mg PO QW or 75mg/day PO for 2 days of each month or 150mg PO monthly. Inj: 3mg IV Q 3 months Oral: PMO prevention & treatment: 150mg PO monthly or 2.5mg PO QD Not recommended if CrCl is less than 35 ml/min Abdominal pain, arthralgia, diarrhea, nausea, rash Nausea, fever, vomiting, dyspnea (not recommended if CrCl is less than 35 ml/min) Nausea, fever, vomiting, dyspnea (not recommended if CrCl is less than 35 ml/min) 1
2 Medication Status zoledronic acid 2 2 inj 5mg/100ml Selective Estrogen Receptor Modifying Agents GIO prevention & treatment and treatment of PMO and Osteoporosis in men: 5mg IV every 12 months. PMO prevention: 5mg IV every 2 months. raloxifene 3 [QL] 3 [QL] PMO prevention & treatment: 60mg PO QD Estrogens (Indicated for Osteoporosis prevention)** Pyrexia, myalgia, headache, arthralgia, extremity pain Hot flashes, arthralgia, sinusitis, flu like syndrome, headache estradiol oral**, estropipate** estradiol patches** estradiol/ norethindrone**, mimvey**, mimvey lo** jinteli** (norethindrone acetate/ ethinyl estradiol) PREMARIN ORAL** (conjugated estrogens) mg PO daily 3 3 Transdermal system: start at 0.025mg per week 3 3 Start at 0.5mg /0.1mg PO QD 3 3 1mg/5mcg PO QD mg PO QD 2
3 Medication PREMPRO**, PREMPHASE** (medroxyprogesterone/ conjugated estrogens) Calcitonin calcitoninsalmon nasal MIACALCIN INJ (calcitonin) Parathyroid Hormone FORTEO (teriparatide) TYMLOS (abaloparatide) Status Start at 0.3mg/1.5mg PO QD spray (200 IU) / day, alternating nostrils IU SQ/IM QOD - QD mcg SC daily RANK Ligand (RANKL) Inhibitor PROLIA (denosumab) GIO (men and women), PMO treatment: 20mcg SC daily Treatment of PMO and Osteoporosis in men: 60mg SC every 6 months Nasal symptoms (e.g., nasal crusts, dryness, redness, nasal sores, irritation, itching, soreness, infection) Injection site reaction, nausea, vomiting Hypertension, arthralgia, rhinitis, nausea, dizziness, pain, asthenia, headache Hypercalciuria, dizziness, nausea, headache, and palpitations Back pain, arthralgia, extremity pain *GIO: glucocorticoid-induced osteoporosis PMO: postmenopausal osteoporosis ** Estrogens with or without progesterone (oral and topical patch products only) are considered High Risk Medications or medications that generally should be avoided in the elderly due to the evidence of carcinogenic potential (breast and 3
4 endometrium) and lack of cardio-protective effect and cognitive protection in older women. Brand-name drugs are capitalized and generic drugs are listed in lower-case italics = Prior Authorization = B versus D determination [QL] = Quantity Limit [ST] = Step Therapy
5 Osteoporosis Guidelines References Osteoporosis Guidelines adapted from: 1. U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med 2011 Mar 1;15(5): Kanis, JA, Borgstrom, F, De Laet. C, et al. Assessment of fracture risk. Osteoporosis International 2005; 16: Raisz, LG. Clinical practice. Screening for osteoporosis. N Engl J Med 2005; 353:16.. Cosman, F., de Beur, S.J., LeBoff, M.S. et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int (201) 25: doi: /s Drug Facts & Comparisons. (2016, Aug.). Retrieved from Wolters Kluwer Health: Deventer, The Netherlands. 6. Epocrates Online. (, Aug). Retrieved from: Epocrates, Inc.: San Mateo, California. 7. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc 2015 Nov; 63(11): Quality Indicators for Care of Osteoporosis in Vulnerable Elders JAGS, 55:S392-S Algorithm of clinical and BMD information to model the 10-year fracture probability in men and women 5
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