Has your patient had a minimal trauma fracture?
OR
Is your patient 70 years or older?
(T-score ≤ -2.5)

Bisphosphonates

  • Reduce vertebral and non-vertebral fractures in postmenopausal women, older men and patients of any age with minimal trauma fracture.
  • Well tolerated with low rate of adverse effects (AE).a Do not use oral bisphosphonates in patients with active upper gastrointestinal tract disorders and watch for symptoms in others.
  • Do not use with other antiresorptive or anabolic agents.

OR

Denosumab

  • Reduces vertebral and non-vertebral fractures in postmenopausal women and vertebral fractures in men.
  • Well tolerated with low rate of AE.a
  • Correct vitamin D deficiency and pre-existing hypocalcaemia before treatment to reduce risk of hypocalcaemia.b

PBS SUBSIDY AVAILABLE FOR:

Alendronate, risedronate and denosumab in patients with minimal trauma fracture or those who are ≥ 70 years with T-score ≤ -2.5. Use of zoledronic acid in patients with minimal trauma fracture or those who are ≥ 70 years with T-score ≤ -3.0.


NOTE:

Is your patient a postmenopausal woman with a minimal trauma fracture and risk of vertebral fractures predominantly?

Raloxifene is an alternative to bisphosphonates or denosumab

  • Reduces vertebral fractures but not nonvertebral fractures in postmenopausal women.
  • Reduces risk of breast cancer so suitable for women at high breast cancer risk.
  • Associated with increased risk of DVT or pulmonary embolism in meta-analyses.

PBS SUBSIDY AVAILABLE FOR:

Patients who are postmenopausal women with previous minimal trauma fracture.


Does your patient have severe ostoporosis (T-score ≤ -3.0) with a very high fracture risk?

Teriparatide

  • Reduces vertebral and non-vertebral fractures in postmenopausal women.
  • Limited evidence for use in men.
  • Available on PBS for continuing treatment in patients with severe osteoporosis and, for this indication, must not exceed lifetime maximum of 18 months.
  • Well tolerated with low rate of AE.
  • Do not use with bisphosphonates.

PBS SUBSIDY AVAILABLE FOR:

Patients with T-score ≤ -3.0 and very high fracture risk and those with ≥ 2 minimal trauma fractures and new fracture after 12 months on another osteoporosis medicine. Must be treated by specialist or consultant physician.



Management of corticosteroid-induced osteoporosis

Has your patient been taking high-dose corticosteroids (≥ 7.5 mg/day prednisolone or equivalent) for 3 months or more?

Bisphosphonates

  • Reduce vertebral and non-vertebral fractures in postmenopausal women, older men and patients of any age with minimal trauma fracture.
  • Well tolerated with low rate of AE.
  • Do not use oral bisphosphonates in patients with active upper gastrointestinal tract disorders and watch for symptoms in others.
  • Do not use with other antiresorptive or anabolic agents.

PBS SUBSIDY AVAILABLE FOR:

Alendronate, risedronate and zoledronic acid in patients with a T-score ≤ -1.5 taking long-term oral corticosteroids.


a Serious adverse effects such as osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFF) have occurred rarely in patients treated for osteoporosis with bisphosphonates or denosumab. Refer to the Osteoporosis medicines tables below for details.

b Refer to the Osteoporosis medicines tables for detailed precautions and contraindications.


NOTE
For PBS-subsidised treatment, fractures must be demonstrated radiologically and the year of the X-ray or scan documented. The PBS defines a vertebral fracture as ≥ 20% reduction in height of the anterior or mid portion of a vertebral body relative to the posterior height of that body, or ≥ 20% reduction in any of these heights compared to the vertebral body above or below the affected vertebral body. Some PBS-listed medicines carry restrictions regarding concomitant treatment with any other PBS-listed antiresorptive agent for the same indication. For the full list of restrictions, refer to the PBS website.

Date published:19 Jul 2016