MSK

Osteoporosis Medications

Musculoskeletal

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Examples

alendronaterisedronateibandronatedenosumabteriparatide

Prefix / Suffix: -dronate for bisphosphonates; -mab for denosumab

Physiology

Bone strength depends on balance between bone breakdown by osteoclasts and bone formation by osteoblasts. Osteoporosis occurs when breakdown exceeds formation, increasing fracture risk.

Mechanism of Action

Bisphosphonates inhibit osteoclast-mediated bone resorption. Denosumab blocks RANKL to reduce osteoclast formation. Teriparatide stimulates bone formation when given intermittently.

Indications

  • Osteoporosis treatment or prevention
  • Fragility fracture risk reduction
  • Glucocorticoid-induced osteoporosis
  • Bone loss from selected cancer therapies

Side Effects / Adverse Effects

  • Esophagitis with oral bisphosphonates
  • Hypocalcemia
  • Musculoskeletal pain
  • Osteonecrosis of the jaw rarely
  • Atypical femur fractures rarely

Contraindications

  • Inability to sit or stand upright after oral bisphosphonate
  • Esophageal disorders delaying emptying
  • Hypocalcemia
  • Severe renal impairment for some bisphosphonates

Nursing Considerations

  • Give oral bisphosphonates first thing in the morning with plain water only
  • Teach patient to remain upright and avoid food/other meds for at least 30 minutes or as directed
  • Ensure calcium and vitamin D are adequate
  • Monitor dental health and jaw pain
  • Teach fall prevention and weight-bearing exercise

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Disclaimer: PharmPal Nurse is for education only and is not medical advice. Do not use it to diagnose, treat, prescribe, or make patient-care decisions; always verify with current drug references, your instructor, facility policy, and a licensed provider. In emergencies, call local emergency services.