Name two first-line pharmacologic therapies for osteoporosis in postmenopausal women.

• A. Bisphosphonates (e.g., alendronate, risedronate, zoledronic acid) and denosumab
• B. Teriparatide and abaloparatide
• C. Raloxifene and calcitonin
• D. Calcium supplements and vitamin D

Answer: (A)

The main idea is that initial drug therapy for postmenopausal osteoporosis centers on antiresorptives that slow bone loss and cut fracture risk. Bisphosphonates (such as alendronate, risedronate, or zoledronic acid) inhibit osteoclast-mediated bone resorption, helping to rebuild bone density over time. Denosumab, a monoclonal antibody against RANKL, prevents osteoclast formation and activity, also reducing bone loss and lowering fracture risk. Both have strong, consistent trial data showing reductions in vertebral and hip fractures and are widely used as first-line because of their proven efficacy, safety profile, and practical use in diverse patients. In contrast, anabolic agents like teriparatide and abaloparatide are typically reserved for those at very high fracture risk or after antiresorptive failure. Raloxifene and calcitonin offer some benefit but have more limited fracture protection, and calcium plus vitamin D are essential supplements that support bone health but do not provide the same level of anti-fracture risk reduction as antiresorptives.