Pharmacological treatment of osteoporosis

Article information

J Korean Med Assoc. 2019;62(10):542-550
Publication date (electronic) : 2019 October 11
doi :
Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Corresponding author: Sungwook Chun.
Received 2019 August 21; Accepted 2019 August 26.


Osteoporosis is a skeletal disorder characterized by compromised bone strength resulting in a predisposition to fracture. Osteoporosis-related fractures can lead to pain, disability, and increased healthcare costs. This study aimed to explore different pharmacological treatments for osteoporosis. Various treatments are used to prevent and treat osteoporosis, particularly in postmenopausal women and elderly men, but the approach needs to be individually tailored. Bisphosphonates are most commonly used to treat osteoporosis. Bisphosphonates and denosumab are mainly used during the initial phase of therapy for most patients with osteoporosis, including those with a high risk of fracture. In younger postmenopausal women, menopausal hormone therapy (including tibolone) and selective estrogen receptor modulators may be considered as alternatives for fracture prevention. Parathyroid hormone therapy is recommended for osteoporosis treatment in elderly patients with an increased risk of multiple vertebral fractures. Dual energy X-ray absorptiometry (DXA) is the mainstay for monitoring the treatment response, and clinicians may consider alternative treatments if a significant decrease in bone mineral density is detected (using DXA or bone turnover markers) or if recurrent fractures occur during treatment. For postmenopausal women undergoing long-term bisphosphonate treatment, the risk of fracture should be reassessed after 3 to 5 years, and a “drug holiday” should be considered if the risk of fracture is low-to-moderate. Therapy should be continued for patients who continue to exhibit a high risk of fracture, or alternatively, switching to other treatments may be considered.


Conflict of Interest

No potential conflict of interest relevant to this article was reported.


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Article information Continued

Figure 1

Algorithm for the drug holiday period during the long-term bisphosphonate therapy in postmenopausal women. IV, intravennous; BMD, bone mineral density. Reproduced from Korean Society for Bone and Mineral Resaerch. Physician's guide for diagnosis and treatment of osteoporosis 2015 [Internet]. Seoul: Korean Society for Bone and Mineral Research; 2015, according to the Creative Commons license [3].

Figure 2

Algorithm for the pharmacological treatment of osteoporosis in postmenopausal women. VMS, vasomotor symptom; MHT, menopausal hormone therapy; SERM, selective estrogen receptor modulator; BMD, bone mineral density; BTM, bone turnover marker.

Table 1

Approved bisphosphonates used in the prevention and treatment of osteoporosis in Korea

Table 1