Postmenopausal osteoporosis therapy reference (2026)

Postmenopausal osteoporosis therapy in 2026 organises around two main mechanism categories.

Anti-resorptive therapy: oral bisphosphonates (alendronate, risedronate, ibandronate) remain widely used; intravenous zoledronic acid is given annually for patients with adherence issues or severe disease. Denosumab is given subcutaneously every six months and is widely used. Calcitonin is largely historic. Selective estrogen receptor modulators (raloxifene) have a niche role.

Anabolic therapy: teriparatide and abaloparatide (PTH and PTH-related-peptide analogues) are given as daily sub-cutaneous injections for up to two years and stimulate new bone formation. Romosozumab (sclerostin inhibitor) is given monthly for one year and has both anabolic and anti-resorptive effects.

Sequencing pattern: the modern preference is to use anabolic therapy first in patients with severe osteoporosis or recent fracture, followed by anti-resorptive therapy to maintain the gains. This anabolic-first sequencing produces better bone-density and fracture outcomes than anti-resorptive-first.

Diagnostic-pathway and post-fracture care: DXA scanning identifies osteoporosis. Post-fracture care pathways (fracture liaison services) substantially improve initiation of appropriate therapy after a fragility fracture but coverage remains uneven across health systems.