The primary treatment recommended for osteoporosis in women over the age of 70 is the use of bisphosphonates. This recommendation is supported by several guidelines:
Bisphosphonates as primary treatment
- The American College of Physicians (ACP) 2024 guidelines recommend bisphosphonates as the initial pharmacotherapy to reduce the risk of fractures in postmenopausal patients with primary osteoporosis
- The American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) 2020 guidelines also recommend initiating alendronate, risedronate, or zoledronate as initial therapy to reduce hip, non-vertebral, and spine fractures in most patients with osteoporosis at high risk of fracture
- The Osteoporosis Canada (OC) 2023 guidelines recommend initiating bisphosphonates (alendronate, risedronate, or zoledronic acid) in patients meeting treatment initiation criteria
Other therapeutic options
- Denosumab is suggested as a second-line pharmacologic treatment to reduce the risk of fractures in postmenopausal females diagnosed with primary osteoporosis who have contraindications to or experience adverse effects of bisphosphonates
- Raloxifene is considered in postmenopausal patients meeting treatment initiation criteria and having contraindications or substantial intolerance to or choosing not to take other suggested therapies
- Romosozumab and teriparatide are suggested for use in females with primary osteoporosis with a very high risk of fracture, followed by a bisphosphonate
Treatment duration and re-evaluation
- The Society of Obstetricians and Gynaecologists of Canada (SOGC) 2022 guidelines recommend initiating bisphosphonates, ideally for up to 5 years, in patients with osteoporosis at intermediate risk of fracture, unless contraindicated. Fracture risk should be re-evaluated after 3–5 years of treatment and a drug holiday should be considered
- The American College of Obstetricians and Gynecologists (ACOG) 2022 guidelines suggest discontinuing bisphosphonates to allow a drug holiday in low-to-moderate risk patients being stable after 5 years of treatment with oral bisphosphonates or after 3 years of therapy with IV zoledronic acid. Treatment may be continued for longer durations of up to 10 years for oral bisphosphonates or up to 6 years for IV zoledronic acid in patients at high risk of fracture
Bisphosphonates are the primary recommended treatment for osteoporosis in women over the age of 70, with other therapeutic options available based on individual patient needs and contraindications. Treatment duration and re-evaluation are important aspects of the management plan.