Class/medication		FDA indication	Fracture type	Typical dosage and monthly cost^27,28		Adverse effects and contraindications	NNT (to prevent one fracture)²⁹
Bisphosphonates				Consider drug discontinuation after 5 years in low-risk patients		Small risk of atypical femoral shaft fractures; osteonecrosis of the jaw
	Alendronate (Fosamax)	Prevention	Hip, vertebral, nonvertebral	5 mg per day or 35 mg per week, oral $53		Mild upper gastrointestinal events, esophageal ulcerations, perforations, bleeding events, muscular and joint pains Contraindications: abnormalities of the esophagus; inability to stand or sit upright for at least 30 minutes; hypersensitivity to any product component; increased risk of aspiration or dysphagia	Hip: 91 (2 to 5 years)
		Treatment	Hip, vertebral, nonvertebral	10 mg per day or 70 mg per week, oral $107
	Alendronate/cholecalciferol (Fosamax Plus D)	Treatment	Hip, vertebral, nonvertebral	70 mg plus 2,800 IU or 5,600 IU per week, oral $140		Same as alendronate	—
	Ibandronate (Boniva)	Prevention and treatment	Vertebral only	150 mg monthly or 2.5 mg per day, oral $153		Same as alendronate	Spine: 20 (3 years)
		Treatment	Vertebral only	3 mg every 3 months, IV $159 (one dose = $477)		Same as alendronate	—
	Risedronate (Actonel)	Prevention and treatment	Hip, vertebral, nonvertebral	5 mg per day or 35 mg per week or 75 mg in two consecutive days per month or 150 mg per month, oral $199		Same as alendronate	Hip: 77 (3 years)
	Risedronate, delayed release (Atelvia)	Treatment	Hip, vertebral, nonvertebral	35 mg per week, oral $168		Same as alendronate	—
	Risedronate with calcium	Prevention and treatment	Hip, vertebral, nonvertebral	35 mg per week (day 1) plus 1,250 mg calcium per day (days 2 to 7 each week), oral $216		Same as alendronate	—
	Zoledronic acid (Reclast)	Prevention	Hip, vertebral, nonvertebral	5 mg every 2 years, IV $45 (one dose = $1,083)		Muscular and joint pains Contraindications: hypocalcemia creatinine clearance < 35 mL per minute per 1.73 m² (0.58 mL per second per m²) and acute renal impairment; hypersensitivity to zoledronic acid or any components of this product	Hip: 91 (3 years) Spine: 30 (2 years; from 1 study of men)
		Treatment	Hip, vertebral, nonvertebral	5 mg per year, IV $90 (one dose = $1,083)
Raloxifene (Evista)		Prevention and treatment	Vertebral only	60 mg per day, oral $198		Pulmonary embolism, thromboembolic events Contraindications: venous thromboembolism; pregnancy, women who may become pregnant, and breastfeeding mothers	Spine: 29 (3 years)
Teriparatide (Forteo)		Treatment (high risk*)	Vertebral, nonvertebral	20 mcg per day for up to 2 years, subcutaneous $1,545		Arthralgia, pain, nausea, transient orthostatic hypotension, hypercalcemia, hyperuricemia Contraindications: hypersensitivity to teriparatide or to any of its components; reactions have included angioedema and anaphylaxis	Spine: 11 (1.5 years)
Denosumab (Prolia)		Treatment (high risk*)	Hip, vertebral, nonvertebral	60 mg every 6 months, subcutaneous $146 (one dose = $881)		Muscular and joint pains; small risk of osteonecrosis of the jaw (especially older women with poor dental hygiene or cancer) Contraindications: hypocalcemia; pregnancy	Spine: 21 (3 years)