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PubMed2004

[Risk factors for osteoporosis and osteoporotic fractures in a series of 5,195 women older than 65 years].

BACKGROUND AND OBJECTIVE: Although the risk factors of osteoporosis are well known, their prevalence in the general population has not been clearly analyzed. The aim of the present study was to determine the prevalence of several risk factors for osteoporosis and fragility fractures in a population of women from Spain. PATIENTS AND METHOD: We recruited 5,195 women aged 65 year or older, attended in 58 primary care centers. Recruitment was done through a non-probabilistic sampling of consecutive cases. Demographic, anthropometric, and clinical variables were collected, and subjects were administered a questionnaire of risk factors for osteoporosis and fragility fractures. RESULTS: The prevalence of main osteoporosis risk factors was: early menopause (< 45 years): 25.4%; history of fragility fractures: 20.1%; familial history of fragility fractures: 16.7%; low weight (< 57 kg): 14.6%. Any of these four factors was present in 56.3% of women. 26.2% of women were treated with benzodiazepines, and 26.7% reported at least one fall during the previous year. We noticed a low prevalence of several risk factors that are commonly reported in Anglo-Saxon series including tobacco and alcohol consumption, low calcium intake and thyroid hormone treatment. CONCLUSIONS: Besides age, the main risk factors of osteoporosis and fragility fractures in our series were a history of fragility fractures, early menopause, benzodiazepine use and previous falls. The evaluation of these risk factors may be an useful tool to identify women at high risk for osteoporosis and to implement appropriate clinical strategies.

Aged↗

PubMed2004

Osteoporosis in men: epidemiology, diagnosis, prevention, and treatment.

BACKGROUND: Osteoporosis and fragility fractures in men account for substantial health care expenditures and decreased quality of life. OBJECTIVE: This article reviews the most current information about the epidemiology, diagnosis, prevention, and treatment of osteoporosis in men. METHODS: Relevant literature was identified through a search of MEDLINE (1966-June 2003) limited to English-language studies in men. The search terms included fractures, bone density, or osteoporosis plus either epidemiology, diagnosis, prevention, control, or therapy. Additional search terms included specific subtopics (eg, bisphosphonates, calcium, exercise, parathyroid hormone). The authors contributed additional relevant publications. RESULTS: Morbidity after fragility fracture is at least as high in men as in women, and the rate of fracture-related mortality 1 year hip fracture is approximately double in men compared with women. The bioavailable fraction of testosterone slowly declines into the ninth decade in men. There is evidence that the effect of estrogen on bone is greater than that of testosterone in men. Diagnosing osteoporosis in men is complicated by a lack of consensus on how it should be defined. Significant risk factors for osteoporosis or fracture include low bone mineral density, previous fragility fracture, maternal history of fracture, marked hypogonadism, smoking, heavy alcohol intake or alcoholism, low calcium intake, low body mass or body mass index, low physical activity, use of bone-resorbing medication such as glucocorticoids, and the presence of such conditions as hyperthyroidism, hyperparathyroidism, and hypercalciuria. Prevention is paramount and should begin in childhood. During adulthood, calcium (1000-1500 mg/d), vitamin D (400-800 IU/d), and adequate physical activity play crucial preventive roles. When treatment is indicated, the bisphosphonates are the first choice, whereas there is less support for the use of calcitonin or androgen therapy. Parathyroid hormone (1-34) is a promising anabolic therapy. There is also strong evidence for the use of bisphosphonates for the treatment of glucocorticoid-induced osteoporosis.

Androgens↗

PubMed1997

Calcium metabolism, osteoporosis and essential fatty acids: a review.

Essential fatty acid (EFA)-deficient animals develop severe osteoporosis coupled with increased renal and arterial calcification. This picture is similar to that seen in osteoporosis in the elderly, where the loss of bone calcium is associated with ectopic calcification of other tissues, particularly the arteries and the kidneys. Recent mortality studies indicate that the ectopic calcification may be considerably more dangerous than the osteoporosis itself, since the great majority of excess deaths in women with osteoporosis are vascular and unrelated to fractures or other bone abnormalities. EFAs have now been shown to increase calcium absorption from the gut, in part by enhancing the effects of vitamin D, to reduce urinary excretion of calcium, to increase calcium deposition in bone and improve bone strength and to enhance the synthesis of bone collagen. These desirable actions are associated with reduced ectopic calcification. The interaction between EFA and calcium metabolism deserves further investigation since it may offer novel approaches to osteoporosis and also to the ectopic calcification associated with osteoporosis which seems to be responsible for so many deaths.

Animals↗

PubMed1994

An association between osteoporosis and premenstrual symptoms and postmenopausal symptoms.

This study examined the relationship of premenstrual and postmenopausal symptoms with vertebral osteoporosis by means of a retrospective case control questionnaire in patients with vertebral osteoporosis and control patients. Seventy-five postmenopausal women aged 55-70 years with vertebral osteoporosis and 77 age-matched controls were interviewed at the outpatient clinics of the Royal Hallamshire Hospital, Sheffield, UK to establish the past history of premenstrual symptoms, and present and past history of postmenopausal vasomotor symptoms. The risk of vertebral osteoporosis was significantly greater in women with a history of premenstrual symptoms (RR = 1.86) or oligomenorrhoea (RR = 3.08). Significantly more patients with osteoporosis than controls recalled vasomotor symptoms at the time of the menopause (RR = 1.35). Patients were more likely than controls to describe their symptoms as severe (RR = 1.43) or persistent (RR = 2.19). We conclude that the relative risk of vertebral osteoporosis is increased in women with a history of premenstrual symptoms, irregular periods, and with severe and/or persistent menopausal vasomotor symptoms.

Adolescent↗

PubMed1994

Polyostotic heterogeneity of the spine in osteoporosis. Quantitative analysis and three-dimensional morphology.

It was the aim of this study to record quantitatively and qualitatively the distribution of the three-dimensional microarchitecture throughout the human spine in osteoporosis. Bone biopsies of the iliac crest and the complete spine of 26 autopsy cases without skeletal disease and 11 female patients with proven osteoporosis were removed. Grindings of all vertebrae by a technique which we developed allowed two- and three-dimensional measurements simultaneously. The analysis included an evaluation of trabecular bone volume, trabecular interconnection, and trabecular thickness, as well as a qualitative investigation of the structure of cancellous bone. The bone loss in osteoporosis is a loss of structure. The relative loss of the trabecular microarchitecture is greater in the iliac crest than in the lumbar spine. It is a gradual change from normal bone to osteoporosis. Transformation from plates to rods and the loss of whole trabeculae are caused by perforations. The polyostotic heterogeneity in osteoporosis is remarkable. Adjacent vertebrae may show differences of up to 100% in bone structure and bone volume. This explains the difficulties in early diagnosis of osteoporosis. Due to the polyostotic heterogeneity it is impossible to define a threshold mineral content for osteoporotic fractures.

Aged↗

PubMed2004

[Secondary osteoporosis and internal medicine].

INTRODUCTION: The term 'primary' osteoporosis refers to osteoporosis that results from the involutional losses associated with aging and, in women, additional losses related to natural menopause. Osteoporosis that is caused or exacerbated by other disorders or medication exposures is referred to as 'secondary' osteoporosis. CURRENT KNOWLEDGE AND KEY POINTS: This article describes the major causes and provides a framework for the diagnostic investigation of patients with suspected of having secondary osteoporosis. There are numerous causes of secondary bone loss, including endocrine disorders, disorders of the gastrointestinal or biliary tract, rheumatic diseases, haematological diseases, immobilization, adverse effects of drug therapy, and a wide miscellaneous group. FUTURE PERSPECTIVES: Secondary osteoporosis is potentially reversible during the treatment of the underlying disease. It must be identified and induce a symptomatic treatment in all cases plus an etiologic treatment when possible.

Diagnosis, Differential↗

PubMed2003

Osteoporosis during continuous androgen deprivation: influence of the modality and length of treatment.

OBJECTIVE: To analyze the prevalence of osteoporosis in patients with prostate cancer with and without androgen ablation. To know the influence of the modality and the length of androgen ablation on the prevalence of osteoporosis. To analyze the relative risk of hip fracture. MATERIAL AND METHODS: In a cross-sectional study, we assessed bone densitometry at the Ward's triangle of the femoral neck in 110 patients with non-metastatic prostate cancer and without biochemical relapse. A cohort of 53 patients under continuous androgen suppression during a median period of 41 months (12-191) formed the study group and 57 age-matched patients that had been submitted to a radical prostatectomy formed a control group. RESULTS: Both subsets of patients had similar mean age (70.4 vs. 69.2, p=0.07). Mean bone mass was 0.70 g/cm2 in patients under androgen suppression and 0.76 g/cm2 in the control group, p=0.06. The rate of osteoporosis was 41.5% (22/53) and 28.1% (16/57) respectively, p=0.16 and the odds ratio was 1.82 (95% CI 0,82-4.03). The rate of osteoporosis was 41.4% (12/29) in patients under maximal androgen blockade and 41.7% (10/24) in patients under chemical castration, p=0.735. According to the length of the androgen suppression the rate of osteoporosis was 36.4% when it was between 12 and 36 months, 42.1% from 36 to 60 months and 50% when it was longer than 60 months. While the overall relative risk of hip fracture in the control group was 2.0, it was 2.4 when the length of androgen suppression was between 12 and 36 months, 2.9 between 36 and 60 months and 3.9 when it was longer than 60 months. CONCLUSIONS: Androgen suppression increases the prevalence of osteoporosis in patients with prostate cancer. The modality of continues androgen suppression seems not to affect its prevalence. However the length of androgen suppression would be related to its development. The relative risk of hip fracture is also increasing during the androgen suppression.

Age Distribution↗

PubMed2000

Development of a questionnaire (OPQ) to assess patient's knowledge about osteoporosis.

OBJECTIVE: to develop a self-administered questionnaire (OPQ) to assess the patient's knowledge about osteoporosis. METHODS: An initial item pool of 71 questions was developed with input from clinicians involved in the management of patients with osteoporosis. It was piloted in ten patients for face validity and comprehension. The questionnaire was then administered to 50 first-time attendees at a specialist osteoporosis unit. After item analysis using index of difficulty and index of discrimination, 20 items were selected for the final questionnaire (OPQ). These were in the areas of general information (5), risk factors (7), consequences and treatment (four each). RESULTS: the average index of difficulty and index of discrimination (D) of the 20 items was 0.56 (>0.75 is suggestive of a poor discriminator) and 54.8% (D value of 50% is associated with highest level of item discrimination) respectively. This means that all the items actively discriminated between high and low scorers. The Flesch readability index was 74.3 (a score between 70 and 100 means a document is easily understood) and the reliability coefficient was 0.84 (acceptable range 0.8-0.9). Criterion validity (verification that the scale measures what it claims to measure) was confirmed by the method of contrasted groups where members of an osteoporosis awareness charity had a significantly higher score than the first time attendees (13.6 +/- 4.3 vs. 8.5 +/- 5.4; P=0.003). CONCLUSIONS: we have developed a self-report, 20-item questionnaire (OPQ) to assess the patient's knowledge about osteoporosis. Psychometric analysis has shown that the items have a satisfactory index of difficulty and discrimination. The OPQ is internally reliable, valid and easily understandable. It can be used to identify individuals in need of educational interventions as well as assess the effectiveness of education efforts as a part of management of osteoporosis.

Female↗

PubMed1999

The prevalence of osteoporosis in the Hong Kong Chinese female population.

OBJECTIVES: This paper aims to present population-based age-related bone mass values in the Hong Kong Chinese female population, and to assess the number and proportion of Chinese women considered osteoporotic according to the WHO diagnostic guidelines. METHODS: A total of 769 community-based female subjects were recruited. Social demographic characteristics of these subjects were similar to the Hong Kong general population. All bone mass measurements were performed by means of a dual energy X-ray densitometry (Norland XR 26) at two sites: lumbar vertebrae L2-L4 and left hip. These values were expressed as T-scores, with reference to the mean bone mineral density (BMD) values of the group aged 21-40 years. RESULTS: The study revealed that, in women aged 60 years and above, their mean BMD values are 30% lower than the young normal mean. The prevalence of osteoporosis at the spine increased dramatically from about 10% in the age group 50-59 to 45% in the group aged 60-69. In women aged 70 onwards, over half have osteoporosis at the hip. The prevalence of osteoporosis at the spine is relatively stable in the age groups above 60, while that for osteoporosis at the hip increased exponentially with age. CONCLUSIONS: The prevalence of osteoporosis in Hong Kong women is comparable to that found in Caucasian populations. Prevention of osteoporosis, involving both immediate and long-term measures, and targeting at different age groups, are required to combat this serious public health problem in Hong Kong.

Absorptiometry, Photon↗

PubMed1999

Moderation of the daily dose of HRT: prevention of osteoporosis.

INTRODUCTION AND METHODS: Osteoporosis is the most common bone disease in clinical practice. Between 30% and 50% of postmenopausal women and almost 50% of all people over the age of 75 are estimated to have osteoporosis. HRT is well known for reducing the risk of osteoporosis in postmenopausal women but compliance with long-term HRT therapy remains low. The use of low dose HRT reduces the estrogenic adverse events which often cause patients to stop therapy. In this paper, the current literature on the benefits of low dose HRT and osteoporosis prevention are reviewed. RESULTS: Various studies have assessed the efficacy of low-dose HRT (25 mcg/day transdermally; 0.3 mg/day orally) in the prevention of osteoporosis. Low dose HRT is effective at reducing bone loss in postmenopausal and oophorectomised women. In one study of 218 postmenopausal women, a dose of 0.3 mg/day of esterified estrogen resulted in a small but significant increase in whole body BMD compared to a decrease in the placebo group. The addition of calcium supplements may have a synergistic effect on the reduction of bone loss. CONCLUSION: Low dose estrogen, taken either orally or transdermally, can prevent or reverse postmenopausal bone loss and appears to be a useful alternative to higher dosages in the prevention and treatment of osteoporosis. The option of starting HRT at low dose gives physicians the ability to titrate doses to suit individual patients whilst ensuring adequate bone protection and the minimum of hyperestrogenic side effects.

Administration, Cutaneous↗

PubMed1998

The role of fluoride in the prevention of osteoporosis.

Osteoporosis defined as low bone mass and increased susceptibility to fracture is a reflection of the sum of peak bone mass and any bone that has been lost once peak mass has been attained. Several strategies have been applied to optimize peak bone mass and to prevent bone loss. Fluoride has greatest potential as a therapy for osteoporosis once bone has been lost. It has been demonstrated both experimentally and clinically to stimulate bone formation directly and to increase bone mass in patients who already have osteoporosis. Several bone formation/stimulation therapies are under development, and some of these have reached the stage of clinical trial. None of these therapies has been as extensively studied as fluoride, and none is sufficiently advanced in development to be clinically available in the next 3 to 5 years. Fluoride therapy for osteoporosis is already performed in many countries, and approval for use in osteoporosis in the United States is pending. The first clinical trials of NaF therapy for osteoporosis were reported by Rich and Ensinck in 1961. Since then, hundreds of reports on the successes and failures of fluoride therapy have appeared in the literature. At first glance, it seems disappointing and inexplicable that, after 40 years of research, fluoride is still considered an experimental drug in the United States. One plausible explanation is that much of the early research on this drug was suboptimal, including the author's contributions. Fluoride as a naturally occurring element is difficult to patent, and this has kept major pharmaceutical companies from investing heavily in fluoride therapy despite its obvious potential. As a result, pharmacologic and pharmacokinetics studies of fluoride are limited in scope, as are phase I and phase II human toxicology and dose-finding studies. Most early studies of large doses of plain NaF were unable to demonstrate a consistent effect on fracture rate despite a consistent and dramatic effect on bone density. Once this became obvious and as new technologies for measuring bone density became available, it became equally clear that future clinical trials would have to be performed using different formulations of fluoride and lower doses. This approach has not resulted in uniformly positive clinical trials, and one must look elsewhere for answers. The most compelling explanation is that the trials have included patients with different severity of disease, suggesting that there is point in the bone loss spectrum at which even a potent bone-stimulating agent such as fluoride is ineffective. This possibility should provoke a reappraisal of the earlier negative studies: was the failure a result of the drug or of patient selection? The answer to this question is crucial, because these failures have cast a long shadow over the safety of fluoride and are contributing more to the absence of this drug from the pharmacopoeia than any other factor.

Bone Density↗

PubMed1997

How do we increase awareness of osteoporosis?

In the UK and throughout Europe 10 years ago, osteoporosis was not a word that existed in the vocabulary of the general public. The majority of doctors had dismissed osteoporosis as a normal process of ageing, affecting only the very elderly and about which nothing could be done. Why should it matter that awareness of osteoporosis was so low among the general public and the medical professions? For the newly launched National Osteoporosis Society in the UK, several questions needed to be answered: if osteoporosis was not an inevitable part of growing old, was it really a disease and how could action be implemented to treat it and prevent it? If fracture numbers and their costs were so much higher than had been thought, who should be informed of this? And if there were ways of treating and preventing osteoporosis, who should be made more aware, what should they be told, and how could such awareness-raising be done and paid for? Before real action could be undertaken, a considerable awareness programme would be needed to radically-alter traditional beliefs about bone health.

Clinical Competence↗

PubMed1998

Benefits of growth hormone treatment on bone metabolism, bone density and bone strength in growth hormone deficiency and osteoporosis.

Bone mass is reduced in patients with GH deficiency (GHD) leading to an increased vertebral fracture rate and clinically significant osteoporosis. Patients with GHD of juvenile onset have reduced skeletal mineralization. When substituting GH in patients with GHD, bone turnover is increased and bone mineral density initially decreases during the first year due to the increase in remodelling space. From the experience in patients with acromegaly, cortical bone mass is increased and trabecular bone mass is normal in eugonadal or decreased in the hypogonadal patients. However, bone mineral content and bone area are increased leading to a higher biomechanical competence of bone as shown in rats. In patients with GHD of juvenile onset, mineralization and bone maturation are achieved during treatment with GH in adult life after having reached final body height leading to an increase in bone mass. The GH/ IGF-I system is dysregulated in patients with post-menopausal osteoporosis. This is shown by reduced systemic IGF and IGFBP-3-levels in osteoporosis suggesting a decrease of endogenous GH-secretion or a dysregulation of the GH receptor system which is beyond the normal ageing process of the GH/IGF system, the "somatopause". A premature somatopause may be responsible for the dysregulation in some patients with osteoporosis. However, 24-h GH profiles do not differ between patients suffering from osteoporosis or osteoarthritis. Treatment of osteoporosis with GH might be beneficial due to the increased bone metabolism and improved bone geometry which occurs with GH. The substantial increase of bone remodelling achieved with GH may be helpful during late post-menopause with decreased bone turnover and impaired osteoblastic function. Using GH to prevent physiological bone loss that occurs with age seems possible, but has to be discussed on an ethical and economic basis.

Acromegaly↗

PubMedDate not supplied

Osteoporosis testing in orthopedic practice.

BACKGROUND CONTEXT: Osteoporosis affects 75 million people in the United States, Japan and Europe. PURPOSE: The purpose of this article is to review the severity of the problem of osteoporosis and thereby report the need for responsibility of today's spine orthopedic surgeons to recognize those at risk for osteoporosis, order diagnostic studies and treat patients' appropriately. STUDY DESIGN/SETTING: A spine specialty clinic took a sample of 325 different patients who had a bone mass densiometer (BMD) test to look at what percent of patients were osteoporotic. RESULTS: Twenty-one and a half percent of the patients tested positive for osteoporosis. CONCLUSION: There are millions of people with osteoporosis in the world's clinics. As the population ages, we will see a dramatic increase in the incidence of this disease unless appropriate intervention is undertaken. Osteoporosis is preventable and treatable.

Bone Density↗

PubMed2001

Effects of clodronate on vertebral fracture risk in osteoporosis: a 1-year interim analysis.

The aim of this study was to determine whether clodronate reduced the incidence of vertebral fractures in patients with osteoporosis. We report here the interim analysis after 1 year of a 3-year double-blind placebo-controlled study. The objectives of the interim analysis were to determine whether there was a trend in fracture frequency and to examine the effects of clodronate on bone mineral density (BMD). Patients with densitometrically proven osteoporosis (T-score <-2.5 and <-3 for women and men, respectively) or with at least one prevalent vertebral fracture were recruited to a 3-year double-blind, controlled study. Patients were randomized to three strata, namely women with postmenopausal osteoporosis (stratum I, n = 483), women with secondary osteoporosis (II, n = 110), and men with osteoporosis of any causation (III, n = 84). They received either clodronate 800 mg daily by mouth or an identical placebo, and all patients received a calcium supplement of 500 mg daily. BMD was measured at six monthly intervals, and lateral spine radiographs for vertebral morphometry were obtained at baseline and 1 year. Treatment with clodronate was associated with a significant increase in BMD at the spine of 3.2 +/- 0.3% (p < 0.0001 vs. baseline) compared with a nonsignificant change of 0.5 +/- 0.3% in the placebo group (p < 0.0001 between treatments). At the hip, clodronate was associated with a significant increase in total hip BMD of 1.3 +/- 0.3% (p = 0.018 vs. baseline) compared with a small decrease of 0.4 +/- 0.3% in the placebo group (p = 0.027 for the difference between treatment groups). The mean changes at the spine and hip were similar in all three strata. Incident vertebral fractures were observed in 27 patients at 1 year in the placebo group (9.0%) and in 14 patients receiving clodronate (4.9%) (relative risk 0.54; 95% CI 0.29-1.02; p = 0.07). A trend was observed in all treatment strata. Treatment was well tolerated, with no significant adverse events attributable to clodronate treatment. We conclude that clodronate 800 mg daily is effective in preventing bone loss, and at 1 year, there is a trend consistent with antifracture efficacy in patients with established osteoporosis regardless of causation.

Bone Density↗

PubMed2002

The cost of osteoporosis in men: the French situation.

The objective of this study was to estimate the annual direct medical costs of osteoporosis and osteoporotic fractures incurred by French men > or =50 years of age. Costs were assessed from a societal perspective for 1999 and expressed in Euros. An expert panel was consulted to identify fractures attributable to osteoporosis according to International Classification of Diseases (ICD)-10 codes. Available age- and gender-specific osteoporosis attribution probabilities (OAP) were used to derive the proportion of health-care utilization for fractures resulting from osteoporosis. Hospital and ambulatory care costs due to fractures were obtained from French databases. A total of 23,260 acute hospitalizations were found to be caused by osteoporosis, 52% of which are for hip fractures. Mean cost per stay varied widely according to the site of fracture, from 1300 (wrist fracture) to 5900 (hip fracture). Consequently, the total cost of acute hospitalization amounts to 97.6 million, with hip fractures accounting for 73.2% of the expenditures. Rehabilitation and convalescence costs were estimated to be 90.8 million, generating a total hospital cost of 188.4 million. The total outpatient costs were estimated to be 9.1 million. Thus, the total medical costs of male osteoporosis amount to 197.5 million. A sensitivity analysis was performed to test the robustness of this figure. We estimate the number of fractures by applying international incidence rates from the literature to the French male population aged > or =50 years, whereas the OAP and unit costs were kept constant. This approach yielded an estimate of 21,857 fractures, which is only 6% below the base case. When compared with values from other countries, our study results appear very conservative.

Aged↗

PubMed2000

The genetics of osteoporosis: 'complexities and difficulties'.

Osteoporosis is characterized by a decrease in bone mass as well as a deterioration of the bone architecture resulting in an increased risk of fracture. Although the disease is multifactorial, twin studies have shown that genetic factors account for up to 80% of the variance in bone mineral density, the best known predictor of the risk of osteoporosis. Some loci, such as the vitamin D and estrogen receptor genes, as well as the collagen type Ialpha1 locus, are promising genetic determinants of bone mass, and possibly other bone phenotypes, but this is controversial and the molecular basis of osteoporosis remains largely undefined. Considering that the effect of each candidate gene is expected to be modest, discrepancies between allelic association studies may have arisen because different populations carry different genetic backgrounds and exposure to environmental factors. Also, we realize the importance of gene-gene as well as gene-environment interactions as significant determinants of bone density and risk of osteoporosis. The use of new tools such as small nucleotide polymorphism maps now allows the possibility to perform allelic association studies in the context of whole-genome search. However, specific study design strategies in large epidemiological studies as well as the best statistical approach will need to be established. We may expect the development of population-specific at-risk profiles for osteoporosis that would include genetic and environmental factors, as well as their interactions. This should eventually lead to better prevention strategies and more adapted therapies against osteoporosis.

Aged↗

PubMed2006

Drug insight: Existing and emerging therapies for osteoporosis.

Osteoporosis is a major public health problem that is characterized by microarchitectural deterioration, low bone mass, and increased risk of fractures. Currently, many women and men affected with this disease are not diagnosed or treated. As osteoporosis is often clinically silent, risk-factor assessment and measurement of BMD are needed to identify those who may benefit from osteoporosis therapy. Although adequate daily intake of calcium and vitamin D, and regular weight-bearing exercise are important for skeletal health, they are not adequate treatments for individuals with osteoporosis. Therapies approved for treatment and/or prevention of osteoporosis in the United States include oral bisphosphonates (alendronate, ibandronate and risedronate), calcitonin, estrogens, teriparatide (parathyroid hormone fragment [1-34]), and raloxifene. For most patients, oral bisphosphonates are the treatment of choice, given the large-scale randomized-trial data demonstrating efficacy in fracture reduction, although bisphosphonates that reduce spine and nonspine fractures (e.g. alendronate and risedronate) are preferred. For high-risk patients (those with very low bone density, or with fractures), teriparatide therapy for 2 years should be considered. The treatment paradigm for osteoporosis will evolve further as promising new treatments progress through clinical development.

Bone Density Conservation Agents↗