Which class of medications is considered first-line therapy to reduce fracture risk in osteoporosis?

• A. Calcitonin
• B. Bisphosphonates
• C. Selective estrogen receptor modulators
• D. Calcium supplements

Answer: (B)

Bisphosphonates are used first-line because they directly slow bone loss by inhibiting osteoclast-mediated bone resorption, which increases bone density and lowers the risk of fractures across vertebral, nonvertebral, and hip sites. This strong, well-supported effect across fracture types makes them the primary disease-modifying therapy for osteoporosis. Common options include alendronate, risedronate, ibandronate, and zoledronic acid.

Calcitonin tends to have weaker fracture prevention data and is not considered a first-line option. Selective estrogen receptor modulators can reduce vertebral fracture risk but do not lower hip fracture risk as effectively and carry thromboembolic risks, so they’re not typically first-line for overall fracture prevention. Calcium supplements are essential for maintaining bone health but do not provide the same antiresorptive effect or fracture risk reduction as these medications.