*Bisphosphonates (e.g. alendronate)

Reduces risk of vertebral,
non-vertebral and hip fractures

Oral: upper GI and bowel disturbance, headache, musculoskeletal pain
Parenteral: flu-like symptoms after first injection

Oesophageal abnormalities and/or problems standing or sitting (oral only), severe renal impairment, pregnancy and breastfeeding, hypocalcemia and other bone and mineral metabolism disturbances 

SERMs
(e.g. raloxifene)

Inhibits bone resorption

Reduces vertebral fracture risk

Leg cramps, oedema, vasomotor symptoms

Pre-menopausal women, history of venous thromboembolism, unexplained uterine bleeding, hepatic impairment, severe renal impairment

*Strontium ranelate

Maintains bone formation and reduces resorption

Reduces risk of vertebral,
non-vertebral and hip fractures

Diarrhoea, headache, nauseas, dermatitis

Cerebrovascular disease, venous thromboembolic event, ischaemic heart disease, peripheral arterial disease, temporary or permanent immobilisation, uncontrolled hypertension, pregnancy, breastfeeding, severe renal impairment

*Monoclonal antibodies
(e.g. denosumab)

Regulates osteoclast development and activity

Reduces risk of vertebral,
non-vertebral and hip fractures

Skin infection, hypocalcaemia

Hypocalcaemia, pregnancy

Teriparatide

Has anabolic skeletal effects

Reduces risk of vertebral and non-vertebral fractures

Headache, nausea, dizziness, postural hypotension

Pregnancy, breastfeeding, severe renal impairment, metabolic bone disease other than OP