A comparison between bisphosphonates and other treatments for osteoporosis.
Since their development 30 years ago, bisphosphonates are now one of the standard therapy in the management of osteoporosis. Improvements in terms of anti-resorptive potency have leaded to new molecules available either orally or intravenously, from weekly to yearly administration. Overall tolerance of bisphosphonates is good with regards to the risk of mandibular necrosis, not comparable with those observed in cancer treatment, and with no causal link yet established in osteoporotic patients. Compliance remains poor and should be improved by a better education of the patients about their treatment. Other treatments like teriparatide, raloxifene or strontium ranelate are now also available and give more therapeutic options but also more questions on the best molecule to choose for each patient. There is currently no valid basis for distinguishing in a formal and objective manner the different new-generation bisphosphonates, in terms of efficacy against either vertebral, peripheral or hip fractures. In a same way, comparison between bisphosphonates and the other treatments available for osteoporosis is hard in absence of proper randomised controlled study. This review gives an overview of the recent data on the efficacity and tolerance of bisphosphonates in the different forms of osteoporosis and compares them to the other treatments currently available.
Le Goff
B
B
INSERM U957, Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Nantes, France. benlegoff@gmail.com
Guillot
P
P
Glémarec
J
J
Berthelot
J M
JM
Maugars
Y
Y
D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D004164:Diphosphonates / Q000009:adverse effects / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D016527:Drug Costs; D016903:Drug Monitoring; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D055118:Medication Adherence; D009942:Organometallic Compounds / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000191:economics; D020849:Raloxifene Hydrochloride / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D019379:Teriparatide / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D013876:Thiophenes / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009942:Organometallic Compounds; D020845:Selective Estrogen Receptor Modulators; D013876:Thiophenes; C081587:strontium ranelate; D019379:Teriparatide; D020849:Raloxifene Hydrochloride