Tablette, Infusion oder Spritze? Wie sich Osteoporose-Medikamente unterscheiden

Postmenopausal women experience ongoing loss of bone mass, with resulting increases in the risk of fracture. This review describes the nature of postmenopausal bone loss, the definition of osteoporosis, and the current status of fracture risk estimation, which is pivotal in osteoporosis management. Important lifestyle measures include taking a balanced diet to maintain a healthy weight throughout life, safe physical activity, not smoking, and moderating alcohol intake. Severe vitamin D deficiency accelerates bone loss so should be avoided. Falls prevention becomes increasingly important with age, since falls cause most fractures. Pharmaceuticals to increase bone mass and prevent fractures either act by inhibiting bone resorption or by stimulating bone formation. Bisphosphonates are the most widely used antiresorptives, often taken as weekly oral doses. The intravenous bisphosphonate, zoledronate, has a long duration of action with effects on bone turnover, density, and fractures over a decade after a single dose. It is increasingly used in both prevention and treatment of osteoporosis. Denosumab is effective in preventing fractures but has a rapid offset of effect after its cessation. Some anabolic agents act via the PTH1 receptor, producing substantial increases in spine bone density but are not yet proven to prevent hip fractures. Romosozumab is a monoclonal antibody directed at sclerostin. It has both anabolic and antiresorptive effects and shows broad antifracture efficac

<h4>Objective</h4>To explore and compare the clinical efficacy and safety of denosumab versus zoledronic acid for the treatment of primary osteoporosis.<h4>Methods</h4>This retrospective cohort study included 413 primary osteoporosis patients (denosumab, <i>n</i> = 198; zoledronic acid, <i>n</i> = 215). All received daily calcium (600 mg) and vitamin D (400 IU), representing the total combined daily intake from diet and supplements. The denosumab group received subcutaneous denosumab 60 mg every 6 months and the zoledronic acid group annual intravenous zoledronic acid 5 mg over 36 months. Outcomes assessed at baseline and after 36 months included bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip; bone turnover markers β-CTX (β-isomerized C-terminal telopeptide of type I collagen) and P1NP (procollagen type I N-terminal propeptide); pain severity using the Visual Analog Scale (VAS); functional impairment using the Oswestry Disability Index (ODI); and incidence of adverse reactions.<h4>Results</h4>After 36 months, BMD at all sites significantly increased from baseline in both groups (<i>P</i> < 0.001). The denosumab group demonstrated greater mean absolute increases in BMD at the lumbar spine (0.13 ± 0.10 vs. 0.10 ± 0.10 g/cm², <i>P</i> < 0.001), femoral neck (0.14 ± 0.06 vs. 0.12 ± 0.05 g/cm², <i>P</i> < 0.001), and total hip (0.09 ± 0.12 vs. 0.05 ± 0.09 g/cm², <i>P</i> < 0.001) compared to the zoledronic acid group. B

Despite the availability of multiple highly effective pharmacologic therapies for osteoporosis, fracture rates in the United States have plateaued or increased in recent years. At the same time, individuals with osteoporosis are exposed to an abundance of digital health information and frequently seek guidance on nutrition, exercise, and other lifestyle strategies to improve bone health. Many endocrinologists, however, may have limited time or expertise to address these questions comprehensively during routine clinical encounters. Current clinical practice guidelines provide valuable direction on selecting pharmacotherapy based on fracture risk, yet they offer limited guidance on how to personalize treatment plans by integrating patient values, beliefs, and preferences. The aim of this manuscript is to equip clinicians with practical, preference-sensitive strategies to address common concerns raised by postmenopausal women with osteoporosis, including evidence-based guidance on nutrition and on safe, effective resistance, impact, and balance-focused exercises for bone health and fall prevention. We also outline suggested approaches for responding to common concerns among patients who are reluctant to initiate pharmacologic therapy. Through 2 illustrative cases, we highlight how clinicians can integrate pharmacologic options with evidence-based lifestyle guidance and engage patients in shared decision making to develop individualized, goal-concordant care plans. Our goal is to