Treatment of Osteoporosis
Several effective medicines are approved for the prevention and treatment of osteoporosis. The efficacy of these agents has been demonstrated by their ability to reduce vertebral, and in some cases non-vertebral, fracture risk in women with osteoporosis.
These agents can be broadly divided into two categories: anti-resorptive (or anti-catabolic) or anabolic agents. Anti-resorptive agents, which include estrogen, selective estrogen receptor modulators, bisphosphonates and the human monoclonal antibody to receptor activator of NFκB ligand (RANKL) reduce bone resorption (and subsequently bone formation), leading to an increase in BMD to varying degrees. In comparison, anabolic agents, which include full-length parathyroid hormone (PTH1-84) and teriparatide (PTH1-34) stimulate bone formation (and subsequently bone resorption), thereby increasing BMD. Strontium ranelate is another agent that reduces fracture risk. It has only weak effects on bone remodeling and probably improves bone strength mainly through effects on bone material properties.
In postmenopausal women with osteoporosis the primary outcome investigated in pivotal pharmaceutical trials is reduction of fracture. Risk reductions of between 30 and 70 % have been demonstrated for vertebral fractures, around 15-20 % for non-vertebral fractures and up to 40% for hip fracture. However, of the currently approved treatments only alendronate, risedronate, zoledronic acid and strontium ranelate have been shown to reduce vertebral, non-vertebral and hip fractures.
In men and in glucocorticoid-treated populations regulatory approval has been obtained on the basis of bridging studies in which similar BMD changes to those seen in postmenopausal women with osteoporosis have been demonstrated.
In addition to drug therapy, calcium and vitamin D supplements should also be prescribed to ensure adequate intake and to ensure maximum effectiveness of the drug therapy.
Doctors and patients should also be aware that attention to lifestyle factors – such as regular weight-bearing exercise, proper nutrition and falls prevention strategies – must go hand in hand with any drug treatment prescribed.
Read about prevention and adherence issues
Updated January 2010
