Medication

Dosage

Cost

Special Considerations

Bisphosphonates

Alendronate

10 mg/d or 70 mg/week; 5 mg/d for prevention

$$$$$

Adherence to dosing instructions required (Table 29.6); used in men and women to prevent glucocorticoid-induced osteoporosis

Etidronate

400 mg/day for 2 weeks every 3 months

$$

May be used in men and women to prevent glucocorticoid-induced osteoporosis; use for idiopathic osteoporosis only if all other treatments are not tolerated or effective

Ibandronate

150 mg/month

$$$$$

Must be taken fasting with water, standing upright and taking nothing by mouth for at least 60 minutes after taking; do not use if creatinine clearance is less than 30 mL/minute

Risedronate

5 mg/d

$$$$$

Adherence to dosing instructions required (see Table 29.6)

Selective estrogen receptor modulator

Raloxifene

60 mg/d

$$$$$

May prevent breast cancer

Calcitonin

Nasal spray

200 IU/d

$$$$$

Metered spray; 1 spray gives daily dose; alternate nostrils each day to reduce side effects

Injectable (subcutaneously or intramuscularly)

50–100 IU 3 to 5 times/week

$$$$

Injectable still useful, depending on patient

Estrogen

See text

$

Not recommended as first-line choice

Parathyroid hormone (teriparatide)

20 μg/d (injection)

$$$$$

For use in patients who cannot tolerate other approved treatments for osteoporosis