PBS-subsidised across several distinct osteoporosis pathways — fracture, age-plus-BMD, glucocorticoid-induced, and second-line/severe disease — each with its own T-score threshold. Confirm the exact current wording for the agent and pathway you're using at pbs.gov.au.
1Eligibility — the pathways
✓Minimal trauma fracture — Fracture due to minimal trauma, radiologically confirmed (date documented). No separate T-score required — the fracture alone qualifies.
✓Age 70+ with low BMD — BMD T-score at or below the PBS threshold for the agent (publicly reported figures include both ≤-2.5 and ≤-3.0 across listings) — confirm the figure at pbs.gov.au.
✓Glucocorticoid-induced — Long-term corticosteroids with BMD T-score below a separately-specified, less severe threshold — confirm current wording.
✓Second-line / severe — New fracture on treatment, or 2+ prior minimal-trauma fractures. Denosumab and zoledronic acid have separate severe-disease listings.
2Which agent
| Agent | Dosing | Practical notes |
|---|
| Alendronate / risedronate | Oral, weekly (or monthly for risedronate) | Commonly first-line; take upright, empty stomach, water only |
| Zoledronic acid | IV infusion, yearly | Adherence-friendly; acute-phase reaction common after dose 1 |
| Denosumab | SC injection, 6-monthly | Never stop abruptly — rebound fracture risk without follow-on |
Verify at PBS — Exact T-score thresholds, age cut-offs, item codes and doses are not reproduced here — they differ by agent/listing and change over time. Confirm vitamin D/calcium replete and a dental check before starting; consider a treatment holiday after several years on bisphosphonates.
3Safety & exclusions
Safety
- Denosumab: don't stop without a follow-on antiresorptive — rebound vertebral fracture risk.
- Atypical femoral fracture & osteonecrosis of the jaw: rare class effects — dental review before starting.
- Hypocalcaemia risk, especially in renal impairment — correct vitamin D/calcium first.
- Oral bisphosphonates: oesophagitis — stay upright 30–60 min after dosing.
Check / exclude
- Confirm current T-score threshold & item code for the specific agent/pathway at pbs.gov.au.
- eGFR: dose-adjust/avoid oral or IV bisphosphonates at very low eGFR; denosumab needs no renal adjustment.
- Confirm the fracture is radiologically documented before using the fracture-alone pathway.
- Exclude secondary causes of bone loss first.
PA-04 v1.0 · Reviewed Jun 2026 · Review Dec 2026
For health-professional use. Eligibility pathway structure summarised from public PBS reporting — confirm exact figures at pbs.gov.au. Covers alendronate, risedronate, zoledronic acid and denosumab — not a complete drug-and-dose matrix.
