Which class of drugs is considered first line treatment for osteoporosis?

Bisphosphonates are considered the first-line treatment for osteoporosis due to their ability to effectively inhibit bone resorption, thereby reducing the risk of fractures. These medications work by binding to bone tissue and inhibiting the activity of osteoclasts, the cells responsible for bone breakdown, which leads to a net gain in bone density. Clinical guidelines widely recommend bisphosphonates as an initial therapy for postmenopausal women and men at high risk for fractures, largely because they have a strong track record of improving bone mineral density and reducing fracture rates.

Calcium supplements, while important for bone health, are typically used as an adjunct to other therapies rather than as a standalone treatment for osteoporosis. They do not directly address the underlying mechanisms of osteoporosis.

Hormone replacement therapy can be beneficial for osteoporosis but is often considered when other treatment options are not suitable due to the associated risks and side effects, especially for long-term use.

Selective estrogen receptor modulators (SERMs) can also be used in the management of osteoporosis, specifically in postmenopausal women. However, they are generally not the first choice compared to bisphosphonates, which are more established in clinical use as the initial treatment option.

Overall, bisphosphon