Evidence based medicine and effective interventions of pharmacological therapy for the prevention of osteoporotic fractures.
Osteoporosis and fractures associated with it constitute a real and serious socio-medical problem, which only recently has come to the forefront of social consciousness. The authors are carrying out a critical re-examination of the medical literature of osteoporosis pharmacological treatment. Particular attention has been paid to studies which show a clear reduction of the primary endpoint that, in the case of this pathology, consists of a reduction of the fracturing event. According to the examination of the clinical studies introduced, antiresorptive bone agents, such as alendronate and risenderonate, turn out to be molecules with higher levels of evidence implicated on the reduction of the main osteoporotic fractures, in particular the reduction of vertebral and femoral fractures. The 10 years long-term extension studies, in particular those that have seen the employment of alendronate, found a positive outcome regarding densitometry data and a favorable trend in antifracture effectiveness. Ibandronate is another amino-bisphosphonate which was recently validated as an effective drug for the treatment of osteoporosis with its documented ability to meaningfully reduce vertebral fractures. Also ranelate of strontium, a drug that seems to explain its own result in a different way from the other antiresorptive bone agents, constitutes another valid alternative in the treatment of this pathology. Both of these molecules however, need further studies in order to estimate their antifracture effectiveness in the long term, particularly those related to femoral fractures. Teriparatide and the entire molecule paratohormone are usually not prescribed for its high cost in treatment and because, typically, patients with high-risk level fractures that are already affected, produce more vertebral fractures from moderate to severe intensity.
Cesareo
R
R
Unit of Internal Medicine, S. Maria Goretti Public Hospital, Latina, Italy. robertocesareo@libero.it
Iozzino
M
M
Alva
D
D
Napolitano
C
C
De Rosa
B
B
Contini
S
S
Mallardo
L
L
Lauria
A
A
Reda
G
G
Orsini
A
A
D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001862:Bone Resorption / Q000517:prevention & control; D002116:Calcitonin / Q000627:therapeutic use; D004002:Clodronic Acid / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D000077557:Ibandronic Acid; D009942:Organometallic Compounds / Q000627:therapeutic use; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D000068296:Risedronic Acid; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D019379:Teriparatide / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009942:Organometallic Compounds; D020845:Selective Estrogen Receptor Modulators; D013876:Thiophenes; C081587:strontium ranelate; D004002:Clodronic Acid; D019379:Teriparatide; D014807:Vitamin D; D002116:Calcitonin; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate