title: A review of clinical trials of therapies for osteoporosis using fracture as an end point.
abstract: As the population ages, fragility fractures grow in importance as a public health problem. The principal goal of osteoporosis therapy is primary and secondary fracture prevention. A growing choice of therapies is now available for the treatment of osteoporosis. In this article, we review their efficacy using fracture prevention as an end point. The considerable heterogeneity among studies with regard to patient age, past fracture history, fracture site, and analytical methods precludes the possibility of performing a meaningful meta-analysis. Fracture outcomes have been reported in clinical trials with calcium supplementation, vitamin D supplementation, estrogen replacement therapy (ERT), calcitonin, etidronate, alendronate, sodium fluoride (NaF), parathyroid hormone (PTH), and raloxifene. Compelling evidence for fracture prevention has been provided for calcium and vitamin D supplementation and alendronate treatment. Evidence of fracture prevention exists for ERT, raloxifene, calcitonin, etidronate, and PTH. Data on NaF are inconsistent. Across agents, there is a trend toward greater efficacy for patients at greatest risk of fracture.
authors.affiliation: Endocrinology Service, Department of Medicine, The Hospital for Special Surgery, New York, NY 10021, USA. blankr@hss.edu
authors.forename: R D
authors.initials: RD
authors.lastname: Blank
authors.forename: R S
authors.initials: RS
authors.lastname: Bockman
mesh_terms: D002116:Calcitonin / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy; D010281:Parathyroid Hormone / Q000627:therapeutic use; D012969:Sodium Fluoride / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D004164:Diphosphonates; D010281:Parathyroid Hormone; D014807:Vitamin D; D012969:Sodium Fluoride; D002116:Calcitonin