Treatment of osteoporosis.
No new compounds were tested in 1991, but more results on available therapeutic options were accumulated. Bisphosphonates and calcitonins appeared to increase bone density when used for a period of 1 to 3 years and to decrease vertebral fracture rate. Estrogen replacement therapy is still the most effective prevention of postmenopausal bone loss. Various studies revealed that the risk of inducing breast cancer has not been established and that estrogen has a strong protective effect against cardiovascular mortality. Screening for osteoporosis at menopause to target estrogen replacement therapy to women at increased fracture risk is recommended. Calcium and vitamin D supplements proved to be of significant value, especially in elderly people, in whom they even decreased fracture incidence. Fluoride demonstrated variable bioavailability. This might explain why certain fluoride studies showed fast increases in bone density with heavy side effects but no effect on fracture rate, whereas fluoride preparations of lower bioavailability were better tolerated and decreased fracture incidence. For almost all drugs, some dose dependence was demonstrated and maximally tolerated doses were established, but minimal effective doses are still unknown. Vertebral fracture rate was more often included as the final criterion in therapeutic trials, whereas long-term effects on hip fracture incidence still need more attention.
Burckhardt
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Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*