Category:Antiresorptives: Difference between revisions

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The older calcitonin medicine (salmon calcitonin nasal spray as Miacalcin or Fortical) has minor antiresorptive effect and minor analgesic effect on the bone pain of recent vertebral fracture; the European Medicines Agency restricted its use in 2012 over a small but real signal of malignancy with chronic use, and it has retreated from routine osteoporosis practice. The sclerostin antibody [[wikipedia:Romosozumab|romosozumab]] (Evenity, Amgen 2019), unique in the category in combining stimulation of bone formation with inhibition of bone resorption, is used for one year of treatment in postmenopausal women at high fracture risk followed by transition to a bisphosphonate or denosumab to maintain the gains; a small but real cardiovascular signal in the ARCH trial has restricted its use in patients with recent myocardial infarction or stroke.

The clinical management of osteoporosis with antiresorptive medicines follows a structured algorithm. Postmenopausal women and men over 50 at significant fracture risk (T-score below -2.5 by DEXA; fragility fracture history; FRAX-tool 10-year risk above country-specific threshold) are offered first-line oral bisphosphonate (alendronate or risedronate) or, in patients with intolerance or contraindication, intravenous zoledronate or subcutaneous denosumab. Patients at very high fracture risk (multiple vertebral fractures, T-score below -3.0 with prior fragility fracture, very low T-score in the context of corticosteroid use) are offered anabolic-first therapy (teriparatide or romosozumab) followed by sequential antiresorptive maintenance. The duration-of-treatment question (the "~~drug~~ holiday" decision after 3-5 years of oral bisphosphonate or 3 years of annual zoledronate, the no-holiday rule for denosumab) is one of the central clinical-decision points in contemporary osteoporosis care.

The clinical management of osteoporosis with antiresorptive medicines follows a structured algorithm. Postmenopausal women and men over 50 at significant fracture risk (T-score below -2.5 by DEXA; fragility fracture history; FRAX-tool 10-year risk above country-specific threshold) are offered first-line oral bisphosphonate (alendronate or risedronate) or, in patients with intolerance or contraindication, intravenous zoledronate or subcutaneous denosumab. Patients at very high fracture risk (multiple vertebral fractures, T-score below -3.0 with prior fragility fracture, very low T-score in the context of corticosteroid use) are offered anabolic-first therapy (teriparatide or romosozumab) followed by sequential antiresorptive maintenance. The duration-of-treatment question (the "medicine holiday" decision after 3-5 years of oral bisphosphonate or 3 years of annual zoledronate, the no-holiday rule for denosumab) is one of the central clinical-decision points in contemporary osteoporosis care.

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