6.6.1.3 Other drug therapies used in osteoporosis

Denosumab

  • Denosumab is recommended in post-menopausal osteoporosis where oral bisphosphonates are unsuitable due to contra-indication (severe GORD), intolerance or compliance issues. Denosumab is an amber list drug. Further details can be found in the Shared Care Guideline.

Hormone Replacement Therapy (HRT)

  • HRT should be considered for women who have experienced a premature menopause to reduce their risk of osteoporotic fractures and for relief of menopause symptoms.
  • HRT should not be considered first-line therapy for the long-term prevention of osteoporosis in women over 50 years of age. It is an option where other therapies are contraindicated, cannot be tolerated, or if there is a lack of response. For most women the benefits of HRT outweigh the small risks up to the age of 60 years and women will gain bone protection if they are taking HRT for symptom relief.

Raloxifene

  • Raloxifene is an alternative option for patients for the secondary prevention of osteoporotic fractures in postmenopausal women in line with NICE TA161. It is not recommended for primary prevention.
  • Raloxifene has not been shown to prevent non-vertebral fractures.

Teriparatide

  • Teriparatide is a red list drug and therefore for specialist use only.