Where Do Bisphosphonates Fit in Your Treatment?

Based on 2023 ACP & 2020 AACE guidelines

What Is Your Fracture Risk? Assessed by your physician using DEXA, FRAX, and clinical history
Moderate to High Risk

Start with a Bisphosphonate

First-line treatment for most patients with osteoporosis. Oral (weekly/monthly) or IV (yearly).

Very High Risk

Start with an Anabolic Agent

EVENITY (12 months) or Forteo (up to 24 months) for patients with severe osteoporosis or multiple fractures.

All Treatment Paths Lead to a Bisphosphonate

Whether first-line or follow-on after EVENITY, Forteo, or Prolia — bisphosphonates are part of nearly every osteoporosis treatment plan.

Drug Holiday Cycle

After 3–5 years, reassess fracture risk. If risk has decreased, take a monitored holiday. Restart when needed.

Ongoing Monitoring

DEXA scans, bone turnover markers (P1NP, CTx), and clinical assessment guide every decision.

Based on Qaseem et al., Ann Intern Med 2023 & Camacho et al., Endocr Pract 2020 • MelioGuide.com