Bisphosphonates are the first-line pharmacologic treatment for postmenopausal osteoporosis and the most commonly prescribed medication for this condition.1 Bisphosphonates, classified as antiresorptive agents, have a very high affinity for bone mineral and bind to hydroxyapatite crystals on bony surfaces, where they inhibit osteoclast-mediated bone resorption.
The primary goal of osteoporosis drug treatment is to reduce risk of clinical fractures. Guidelines agree that pharmacologic therapy should be initiated in postmenopausal women with osteoporosis manifested by a hip or spine bone mineral density (BMD) T score less than or equal to −2.5 or personal history of fragility fracture (eg, hip, radiographic or clinical vertebral). Some organizations also recommend treatment initiation in postmenopausal women with osteopenia (BMD T score between −2.5 and −1.0) who have a 10-year fracture probability (calculated using the FRAX tool) at or above intervention thresholds proposed by the National Osteoporosis Foundation, but the benefit of treatment in patients selected on the basis of these criteria has not been assessed in clinical trials.
Ensrud KE, Crandall CJ. Bisphosphonates for Postmenopausal Osteoporosis. JAMA. 2019;322(20):2017–2018. doi:https://doi.org/10.1001/jama.2019.15781
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