Managements of osteoporotic vertebral compression fractures: A narrative review

Table 1 Pharmaceutical management of osteoporosis and efficacy

Drug	Dosing	Efficacy	Adverse effects
Bisphosphonates
Alendronate	10 mg daily, PO; 70 mg weekly, PO	RR of 0.55 in postmenopausal women compared to placebo	Esophageal irritation; Dyspepsia; Acute phase reaction; Atrial fibrillation; Musculoskeletal pain; Renal toxicity; Atypical fracture; Osteonecrosis of the jaw
Ibandronate	2.5 mg daily, PO; 150 mg monthly, PO; 3 mg every 3 mo, IV	RR between 0.50 and 0.62 in postmenopausal women compared to placebo
Risedronate	5 mg daily, PO; 35 mg weekly, PO; 150 mg monthly, PO	RR of 0.64 in postmenopausal women compared to placebo
Zoledronate	5 mg annually, IV	7% increase in spine BMD; RR of 0.23 in postmenopausal women compared to placebo
Rankl inhibitors
Denosumab	60 mg every 6 mo, SQ	68% decrease in incidence of radiographic vertebral fractures; 9.2% increase in lumbar spine BMD	Fatigue; Weakness; Diarrhea; Hypophosphatemia
Hormones
Raloxifene (SERM)	60 mg daily, PO; 120 mg daily, PO	RR of 0.65 in postmenopausal women compared to placebo (60 mg); RR of 0.54 in postmenopausal women compared to placebo (120 mg); 2.6% increase in lumbar spine BMD (60 mg); 2.5% in lumbar spine BMD (120 mg)	Flu syndrome; Vasodilation; Endometrial cavity fluid; Peripheral edema
Teriparatide (PTH)	20 microg daily, SQ; 40 microg daily, SQ	65% decrease in fracture risk (20 microg); 69% decrease in fracture risk (40 microg); 9% increase in lumbar spine BMD (20 microg); 13% increase in lumbar spine BMD (40 microg)	Nausea; Headache; Dizziness; Leg cramps
Calcitonin (TH)	200 mg daily, IN	33% decrease in fracture risk; 1%-1.5% increase in lumbar spine BMD	Epistaxis; Rhinitis; Ulceration of nasal mucosa; Hypocalcemia
Supplementations
Vitamin D	400 IU daily, PO	15% decrease in fracture risk	-
Calcium	1500 mg daily, PO

PO: Orally; RR: Relative risk; IV: Intravenous; BMD: ; SQ: Subcutaneous; IN: Intranasal; SERM: Selective estrogen receptor modulators; PTH: Parathyroid hormone; TH: Thyroid hormone; IU: International unit.