Endocrinology Made Simple : Medications used for improving BMD : Bone Mineral Density

The following are major risk factors for fragility factors :

Low bone density

History of fragility fractures

Family history of osteoporosis

Smoking

Body weight less than 127 pounds

Medications used for improving BMD : Bone Mineral Density

Following medications are used to improve BMD and hence to reduce risk of fragility fractures.

Calcium and Vitamin D supplementation

Adequate vitamin D supplementation and Calcium is the single most important intervention for prevention of osteoporosis.

Anti-resorptive medications/Alendronate :

These are indicated to prevent risk of fragility fractures.

This is a bisphosphonate.

It improves BMD by reducing bone resorption.

It specifically increases BMD at the hip and lumbar spine.

Another example of bisphosphonates is risedronate which is also used for treatment of osteoporosis but it has more GI side effects.

Calcitonin

This also inhibits bone resorption

It causes improvement in vertebral BMD and hence reduces the incidence of vertebral fractures.

It has slight analgesic effect as well and hence can reduce pain from vertebral fracture.

PTH subcutaneous injections/Parathyroid hormone:

This is very effective in increasing BMD at the lumbar spine and in significantly reducing the incidence of vertebral fractures.

It is an expensive treatment and is used only if a failure by bisphosphonates to improve BMD occurs.

HRT is no longer used for treatment of post menopausal osteoporosis due to it causing increased risk of the following :

Stroke

DVT and Pulmonary embolism

Myocardial infarction

Ca breast