Bisphosphonates
Osteoporosis and Fracture Prevention: Bisphosphonates are the most widely used medications for osteoporosis. Alendronate, risedronate, ibandronate, and zoledronic acid are the most common. Alendronate reduces vertebral fractures by 50% and non-vertebral fractures by 50% in women with prevalent vertebral fractures. It reduces hip fracture risk by 34% in the oldest old patients (Black et al., 1996; Cummings et al., 1998; Axelsson et al., 2017). Yearly IV zoledronic acid reduces vertebral fractures by 70% and hip fractures by 40% in postmenopausal women. It also reduces fracture risk when given after a hip fracture (Black et al., 2007; Lyles et al., 2007). A 2017 meta-analysis found bisphosphonates significantly reduced overall osteoporotic fracture risk (OR 0.62), vertebral fractures (OR 0.55), and non-vertebral fractures (OR 0.73) compared to placebo. Zoledronic acid showed the greatest reduction in overall fracture risk (OR 0.61) (Tan et al., 2017). Muscle Mass and Strength: Some evi