← Return to 2 fractures and which drug best to start.

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Profile picture for oopsiedaisy @oopsiedaisy

I am not sure if the video above discusses the different classes of medication used in osteoporosis but to summarize, there are basically three:

1. Bisphosphonates which slow or suppress bone metabolism. This includes both bone breakdown and bone building. If you have already fractured, taking a bisphosphonate may help prevent additional fractures but it's clear that your bones are already fragile. Bisphosphonates include alendronate (Fosamax), zolendronate (Reclast), risendronate (Actonel), and ibandronate (Boniva). These can be taken orally or intravenously.
2. Parathyroid hormone replacement drugs which encourage bone metabolism, including both bone breakdown and bone building. This class of medication may help you replace the fragile, degraded bone that you have and provide additional protection against fractures. There are two currently in use: teriparatide (Forteo) and abaloparatide (Tymlos). Both require daily injections over a two-year period.
3. Monoclonal antibodies which also work on bone metabolism. These also impact bone breakdown and building. The two that are used are denosumab (Prolia) and romosozumab (Evenity). These are injections that are given every 6 months (Prolia) or every month (Evenity).

The last two are considered anabolic in nature because they encourage the production of new bone.

With two fractures, you would be considered as having severe osteoporosis and that makes you a candidate for an anabolic medication (#2 or #3).

Taking a bisphosphonate first may reduce the effectiveness of an anabolic medication taken later. This is why the expert consensus recommends using an anabolic medication first.

I was on Fosamax for over five years and had a fracture just after the five-year mark. I've been on a series of anabolic medications (Tymlos, then Forteo, and now Evenity) for just over a year. It's unknown at this point how effective this will be for me since my bone metabolism was suppressed by the Fosamax for so long. I will find out next year after my Evenity treatments are finished.

A specialist can guide you best in which anabolic is best. Evenity does carry a risk for people with cardiac issues while the PTH replacement drugs have side effects that can be untenable.

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Replies to "I am not sure if the video above discusses the different classes of medication used in..."

I agree that i need more than bisphosphonates because I have had severe osteoporosis diagnosis since menopause (25 years ago). I chose to go with nutrition and exercise and LIV as long as I could. So now after the fractures I’ll do the meds. Just want to take the right one and that’s where I’d like a specialist involved. (I’ll try the pill while waiting)
Thanks for your info.

That's a nice breakdown, oopsiedaisy. One small tweak: denosomab (Prolia) is classed as anti-resorptive, since it boosts BMD by preserving existing bone and allowing secondary mineralization, rather than truly building new bone.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3549483/#:~:text=Almost%20all%20pharmacological%20agents%20for,increases%20(11%E2%80%9313).