Introduction
Background
Saudi Osteoporosis Society Task Force
Diagnosis of osteoporosis
Risk assessment
Age (years) | Intervention thresholds a (%) | Assessment threshold | ||||
---|---|---|---|---|---|---|
Lower b (%) | Upper c (%) | |||||
MOF | HF | MOF | HF | MOF | HF | |
40 | 0.48 | 0.05 | 0.21 | 0.01 | 0.58 | 0.06 |
45 | 0.97 | 0.13 | 0.43 | 0.03 | 1.16 | 0.16 |
50 | 1.97 | 0.32 | 0.89 | 0.08 | 2.36 | 0.38 |
55 | 3.88 | 0.66 | 1.81 | 0.19 | 4.66 | 0.79 |
60 | 5.86 | 1.08 | 2.84 | 0.37 | 7.03 | 1.30 |
65 | 7.00 | 1.54 | 3.51 | 0.62 | 8.40 | 1.85 |
70 | 7.58 | 2.10 | 3.96 | 0.99 | 9.10 | 2.52 |
75 | 7.25 | 2.36 | 4.01 | 1.30 | 8.70 | 2.83 |
80 | 5.90 | 2.13 | 3.49 | 1.37 | 7.08 | 2.56 |
85 | 4.50 | 1.93 | 2.68 | 1.24 | 5.40 | 2.32 |
90 | 3.00 | 1.51 | 1.80 | 0.97 | 3.60 | 1.81 |
Bone turnover markers for osteoporosis
Non-pharmacological management
General pharmacological management
Category | First-line therapy | Alternative first-line therapies |
---|---|---|
Young postmenopausal with only vertebral osteoporosis and history of or at high risk for breast cancer | Raloxifene Falling out of favor due to the presence of more effective and safer medications | Oral bisphosphonates IV bisphosphonates Denosumab Teriparatide |
Older postmenopausal/or younger but with concerns of hip fracture | Oral bisphosphonates* Denosumab | IV bisphosphonate Teriparatide Romosozumab |
Osteoporosis in men | Oral bisphosphonates* Denosumab | IV bisphosphonate Teriparatide |
Severe osteoporosis Very low BMD T≤3.0 + one fracture or ≤2.5 + 2 fractures OR Imminent fracture risk (in the immediate post-fracture period) | Teriparatide Romosozumab | Oral bisphosphonates IV bisphosphonate Denosumab |
Glucocorticoid-induced osteoporosis (GIOP) | Oral bisphosphonates IV bisphosphonate Denosumab Teriparatide |
Bisphosphonates
Parathyroid hormone (PTH) analogs
Selective estrogen receptor modulators (SERMs)
Molecular-targeted drugs: denosumab and romosozumab
Drug | Treatment dose | Duration |
---|---|---|
Alendronate (Fosamax) | 70 mg PO weekly A 70 mg + vitamin D | 5 years |
Denosumab (Prolia) | 60 mg SQ every 6 months | Unlimited |
Raloxifene (Evista) | 60 mg PO daily | 10 years |
Romosozumab (Evenity) | 210 mg SQ monthly | One year |
Teriparatide (Forteo) (Bonteo: biosimilar available in KSA) | 20 µg SQ daily | 2 years, course can be repeated |
Zoledronate (Reclast, generic) | 5 mg IV once yearly | 3 years |