Mechanism of action | Fracture efficacy | |
Bisphosphonate (etidronate, ibandronate, alendronate, risedronate, zoledronate) |
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Selective Estrogen Receptor Modulator (SERM): for example Raloxifene | Inhibit bone resorption. | Reduce vertebral fracture by 35% with no decrease in non-vertebral and hip fracture in a meta-analysis. |
Recombinant Human Parathyroid Hormone (PTH) | Anabolic: stimulates bone formation by reducing osteoblastic apoptosis and increasing osteoblast numbers and differentiation. | Reduces vertebral and non-vertebral fractures. Decrease vertebral fractures by 65% and non-vertebral by 54%. |
Strontium Ranelate | Inhibit bone resorption and increase bone formation | Reduce vertebral fractures by 40%, and to a lesser extent non-vertebral fractures by 16% in meta-analysis. Decreased hip fracture by 36% in post hoc subgroup analysis in women aged 74 years or older. |
Tibolone | Synthetic steroid with oestrogenic, androgenic, and progestagenic properties. | Reduce vertebral fractures by 45% and non-vertebral by 26% in postmenopausal women with improvements in BMD. |
Testosterone | Increase bone formation. | Demonstrated to improve BMD in men with hypogonadism. Effects on fracture reduction unclear. |
Denosumab | Blocking antibody to Receptor activator of NF–κβ Ligand (RANKL) which inhibits osteoclast formation and bone resorption. | Reduce vertebral fractures by 68%, non-vertebral by 20% and hip fractures by 40% in postmenopausal women, associated with increases in BMD and reciprocal decreases in markers of bone resorption |
↵* Based on available evidence, only three of the bisphosphonates that is alendronate, risedronate and zoledronate reduce risk of hip fractures.
RCT, Randomized Control Trial; BMD, bone mineral density.