A rational approach to evidence gaps in the management of osteoporosis.
Major advancements in the treatment of osteoporosis have occurred over the last decade. Therapies including the anti-resorptive drugs such as alendronate and risedronate have been shown in randomized placebo-controlled trials to increase bone mineral density and reduce fracture risk. Anabolic therapy in the form of parathyroid hormone has been introduced as the first treatment to build bone mass. However, gaps in our knowledge about specific management issues that arise frequently among primary care providers persist. In this paper, three common clinical scenarios are discussed: a postmenopausal woman with only slightly reduced bone mineral density; an osteoporotic woman on anti-resorptive therapy for more than 5 years; and a woman who continues to fracture despite treatment. Evidence gaps in each treatment scenario are presented, and rational approaches to management are suggested.
Rosen
Clifford J
CJ
Maine Center for Osteoporosis Research and Education, St. Joseph Hospital, Bangor, Me 04401, USA. rofe@aol.com
Brown
Sue A
SA
D000367:Age Factors; D000368:Aged; D000818:Animals; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy; D001862:Bone Resorption / Q000517:prevention & control; D019090:Case Management; D015331:Cohort Studies; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006306:Health Surveys; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood / Q000627:therapeutic use; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D051381:Rats; D018570:Risk Assessment; D016103:Spinal Fractures / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D004967:Estrogens; D010281:Parathyroid Hormone; D020849:Raloxifene Hydrochloride