title: Long-term treatment of osteoporosis in postmenopausal women: a review from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF).
abstract: BACKGROUND
  Postmenopausal osteoporosis is a chronic disease requiring treatment that balances long-term fracture efficacy against risk.
  
  
  METHODS
  We reviewed the efficacy and safety of calcium and vitamin D, the selective estrogen receptor modulators (SERMs), the bisphosphonates, denosumab, and strontium ranelate in studies of 3 years or longer.
  
  
  RESULTS
  Six trials lasted for 5 years, and seven went beyond that. The evidence beyond 5 years is generally weak, mainly due to methodological issues (open-label design, small samples, or absence of placebo control). Although calcium and vitamin D appear to be beneficial, the data are insufficient to evaluate benefits and risk beyond 3 years. The fracture efficacy of SERMs beyond 5 years is not known, though increases in bone mineral density (BMD) appear to be maintained. The SERMs have good long-term safety, including protective effects against breast cancer. The bisphosphonates have established fracture efficacy to 3 years, and 4 or 5 years with alendronate and risedronate. The evidence beyond 5 years indicates sustained increases in BMD. The safety of the bisphosphonates does not appear to be modified with time, with the possible exceptions of atypical subtrochanteric fracture and other events of unknown frequency. Denosumab has been tested up to 5 years, with continued increased in BMD and no reported safety issues. There is evidence for fracture efficacy of strontium ranelate, and sustained increases in BMD over 10 years. Strontium ranelate has good long-term safety.
  
  
  CONCLUSIONS
  Robust long-term studies are relatively rare for the osteoporosis treatments, and generally show maintenance of BMD and, for some agents, an additional reduction in fracture incidence.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: J-Y
authors.initials: JY
authors.lastname: Reginster
authors.forename: B
authors.initials: B
authors.lastname: Cortet
authors.forename: M
authors.initials: M
authors.lastname: Diaz-Curiel
authors.forename: R S
authors.initials: RS
authors.lastname: Lorenc
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
mesh_terms: D000368:Aged; D019386:Alendronate / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002136:Calcium, Dietary / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D009942:Organometallic Compounds; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D000068296:Risedronic Acid; D013876:Thiophenes; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; D009942:Organometallic Compounds; D013876:Thiophenes; C081587:strontium ranelate; D014807:Vitamin D; D000068296:Risedronic Acid; D012968:Etidronic Acid; D019386:Alendronate