Drug-Related Adverse Events of Osteoporosis Therapy Moin Khan, MD, MSc, FRCSC a,1 , Angela M. Cheung, MD, PhD, FRCPC b,1 , Aliya A. Khan, MD, FRCPC a, * ,1 INTRODUCTION Postmenopausal osteoporosis is associated with microarchitectural deterioration and an increased risk of fracture. 1 Osteoporosis therapy has been demonstrated to effec- tively reduce the risk of vertebral, nonvertebral, and hip fracture and also has been associated with increased survival. 1 Currently approved treatments for osteoporosis include bisphosphonates, denosumab, selective estrogen receptor modulators, and Disclosures: Dr Moin Khan reports no disclosures; Dr Angela Cheung reports honoria from Amgen, Lilly, and Merck for consultation and/or CMEs; Dr Aliya A. Khan reports research grants from Amgen, Meck, and Shire. a McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada; b University of Toronto, 200 Elizabeth Street, 7 Eaton North Room 221, Toronto, ON M5G 2C4, Canada 1 Present address: #223, 3075 Hospital Gate, Oakville, Ontario, Canada. * Corresponding author. E-mail address: Aliya@mcmaster.ca KEYWORDS  Bisphosphonates  Denosumab  Raloxifene  Teriparatide  Atypical femoral fractures  Osteonecrosis of the jaw KEY POINTS  Bisphosphonates and denosumab are effective in reducing the risk of vertebral, nonver- tebral, and hip fracture and are well tolerated with only minor side effects with short- term use.  Long-term use of bisphosphonates and denosumab is associated with a small increased risk of atypical femoral fracture and rarely osteonecrosis of the jaw; these uncommon adverse events can be prevented or identified early with close monitoring and patient education.  Teriparatide, an anabolic agent, is effective in reducing the risk of vertebral and nonverte- bral fracture and is well tolerated with minor side effects.  Raloxifene and bazedoxifene are effective in lowering the risk of vertebral fracture only and are associated with hot flashes and an increased risk of thromboembolic events.  Pharmacologic intervention requires careful review of fracture risk and in the absence of contraindications the benefits are far greater than the potential risk of therapy. Endocrinol Metab Clin N Am 46 (2017) 181–192 http://dx.doi.org/10.1016/j.ecl.2016.09.009 endo.theclinics.com 0889-8529/17/ª 2016 Elsevier Inc. All rights reserved.