Other drugs for osteoporosis (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

DENOSUMAB

Therapy notes


MHRA advice: Denosumab 60mg (Prolia): should not be used in patients under 18 years due to the risk of serious hypercalcaemia (May 2022) (www.gov.uk).
MHRA advice: Denosumab 60mg (Prolia): increased risk of multiple vertebral fractures after stopping or delaying ongoing treatment (August 2020) (www.gov.uk).
MHRA advice: Denosumab (Prolia, Xgeva): reports of osteonecrosis of the external auditory canal (June 2017) (www.gov.uk).
MHRA advice: Denosumab (Xgeva, Prolia): intravenous bisphosphonates: osteonecrosis of the jaw - further measures to minimise risk (July 2015) (www.gov.uk).

Formulation and dosage details

Formulation:

Solution for injection 60mg/1mL, 120mg/1·7mL

Dosage:

Treatment of postmenopausal osteoporosis, by subcutaneous injection, 60mg every 6 months.

  • To be prescribed as per SMC 651/10.
  • See: Rheumatology Denosumab GP info (NHS Highland intranet access required).

ESTRADIOL

Therapy notes

Formulation and dosage details

Formulation:

Gel (Oestrogel® Pump-Pack 0.06%) 750 microgram/actuation

Dosage:

Apply 1·5mg once daily continuously, to be applied over a large area, to be used with cyclical progestogen for at least 12 days of each cycle in women with a uterus.  If switching from cyclical HRT, start at end of regimen; otherwise start at any time.

ROMOSOZUMAB

Therapy notes


Formulation and dosage details

Formulation:

Solution for injection, pre-filled pen (Evenity) 105mg (specialist use only)

Dosage:

As per SMC 2280: treatment of severe osteoporosis in postmenopausal women at high risk of fracture.
SMC restriction: to use in patients who have experienced a fragility fracture and are at imminent risk of another fragility fracture (within 24 months). 

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

TERIPARATIDE

Therapy notes

Formulation and dosage details

Formulation:

Injection, pre-filled pen, 600 micrograms/2·4mL (specialist use only)

Dosage:

By subcutaneous injection, 20 micrograms daily. Maximum duration of treatment is 24 months.

Notes:

Homecare is the preferred option - contact nhsh.homecare@nhs.scot

ZOLEDRONIC ACID

Therapy notes

MHRA advice: Intravenous zoledronic acid: adverse effects on renal function (December 2014) (www.gov.uk).

Risk minimisation materials

  • Treat with Adcal D3® for at least 10 days following infusion.

Formulation and dosage details

Formulation:

Infusion 5mg/100mL (specialist use only)

Dosage:

By intravenous infusion, treatment of postmenopausal osteoporosis and osteoporosis in men (including corticosteroid-induced osteoporosis), 5mg annually as a single dose infused over 15 to 30 minutes, correct any vitamin D deficiency or hypocalcaemia prior to infusion, refer to protocol.
In general this is given annually for 3 years.

Treatment of Paget’s disease of bone, 5mg as a single dose infused over at least 15 minutes

Editorial Information

Document Id: F186