Injectable Osteoporosis Medications for High-Risk Patients with Fall Risk

Introduction to Injectable Osteoporosis Medications

The American College of Rheumatology conditionally recommends denosumab for adults ≥40 years at high fracture risk 2, 3
The American College of Rheumatology conditionally recommends PTH/PTHrP agents (like teriparatide) over antiresorptive agents in very high-risk patients 2, 3, 1

The American College of Rheumatology conditionally recommends teriparatide for patients at very high fracture risk 2, 3
The American College of Rheumatology recommends sequential therapy with bisphosphonates after stopping denosumab to prevent rebound bone loss and increased risk of multiple vertebral fractures 1

Zoledronic acid 5 mg given as a single yearly 15-minute infusion reduces vertebral fractures by 70% over 3 years 4
The American College of Rheumatology conditionally recommends zoledronic acid for moderate, high, and very high-risk patients 2, 3
Very high fracture risk is defined as prior osteoporotic fracture(s), BMD T-score ≤-3.5, FRAX 10-year risk of major osteoporotic fracture ≥30% or hip ≥4.5%, or high-dose glucocorticoids (≥30 mg/day for >30 days) 5, 1

High fall risk patients should be specifically evaluated for fracture risk using FRAX (adjusted for glucocorticoid use if applicable) and BMD testing 2, 1
For glucocorticoid users taking >7.5 mg/day prednisone, multiply FRAX major osteoporotic fracture risk by 1.15 and hip fracture risk by 1.2 5, 1
Adequate calcium (1000-1200 mg/day) and vitamin D (600-800 IU/day) supplementation is necessary with all osteoporosis treatments 4, 1