Topic overview

Start with the big picture

Calcium and vitamin D provide a foundation for prevention and treatment. Bisphosphonates are major anti-resorptive options, while denosumab requires a plan for transition when discontinued because bone density can rebound and vertebral fracture risk can rise. SERMs primarily reduce vertebral fractures, and hormone therapy may be considered for selected symptomatic women, with risks that limit long-term use. For severe or very high-risk disease, anabolic options include parathyroid hormone analogs and romosozumab, each with specific duration or safety considerations. Calcitonin has limited fracture efficacy, and agents such as thiazides or cinacalcet serve particular clinical contexts rather than routine osteoporosis treatment. The lesson also addresses disease-specific considerations and follow-up.