NICE ( National Institute for Health and Clinical Excellence ) recommends a range of treatment options for reducing the risk of postmenopausal women suffering either a first osteoporotic fracture or a further fracture. Most women are prescribed Alendronate ( Fosamax ) in the first instance before being prescribed Risedronate ( Actonel ) or Etidronate ( Didronel ), but for some, these drugs ( classed as oral bisphosphonates ) may be unsuitable. For example, some postmenopausal women may not be able to comply with the special instructions for administration of oral bisphosphonates, or they may have a contraindication to, or intolerance of, oral bisphosphonates.
For certain women at increased risk of fractures, Denosumab ( Prolia ) is now one of the possible treatment options. Denosumab helps stop a fracture from occurring in the first place, or helps women who have previously had a fracture.

Denosumab is a monoclonal antibody that reduces osteoclast activity, and so reduces bone breakdown. Denosumab is recommended as a treatment option for the primary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures: who are unable to comply with the special instructions for administering Alendronate and either Risedronate or Etidronate, or have an intolerance of, or a contraindication to, those treatments and who have a combination of T-score, age and number of independent clinical risk factors for fracture at which Denosumab is recommended when Alendronate and either Risedronate or Etidronate are unsuitable.

Denosumab is recommended as a treatment option for the secondary prevention of osteoporotic fragility fractures only in postmenopausal women at increased risk of fractures who are unable to comply with the special instructions for administering Alendronate and either Risedronate or Etidronate, or have an intolerance of, or a contraindication to, those treatments.

People receiving Denosumab for the primary or secondary prevention of osteoporotic fragility fractures who do not meet the criteria specified in recommendations should have the option to continue treatment until they and their clinician consider it appropriate to stop.

Denosumab is administered as a single subcutaneous injection into the thigh, abdomen or the back of the arm. The recommended dosage is 60 mg once every six months.

Source: NICE, 2010

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