New developments in the treatment of osteoporosis.
The last 25 years have seen the development of a plethora of new, effective agents for the treatment of osteoporosis. These agents reduce the risk of spine fractures by up to 70%, hip fractures by 40-50% and non-vertebral fractures by up to 50-80%. Amino-bisphosphonates, taken orally or intravenously, remain the dominant treatment modalities for osteoporosis. These so-called anti-resorptive or anti-catabolic agents stabilize the skeleton and reduce fracture risk in osteoporotic as well as osteopenic individuals. A monoclonal antibody against receptor activator of nuclear factor κB ligand, Denosumab, constitutes a new anti-resorptive agent recently approved worldwide. In younger postmenopausal women, low-dose estrogen or estrogen/progestin still has a place for short-term (up to 5 years) preservation of bone mass, especially in women with menopausal symptoms. Likewise, selective estrogen receptor modulators should be considered in younger postmenopausal women, especially those at increased risk of breast cancer. Anabolic (bone forming) regimens, of which parathyroid hormone is the only agent currently available, aid in the build up of new bone, increase bone mass and improve bone architecture. In cancellous bone, 30-60% increases of bone mass have been documented, but cortical bone thickness also increases. These improvements lead to profound reduction in fracture rates in both the axial and appendicular skeleton. Owing to cost and the need for parenteral administration, in most countries these agents are reserved for severe osteoporosis with multiple fractures.
Department of Clinical Endocrinology, Oslo University Hospital, Aker, Oslo, Norway. e.f.eriksen@medisin.uio.no
Erik Fink
EF
Eriksen
Johan
J
Halse
Mette Haase
MH
Moen
D000465:Algorithms; D000855:Anorexia / Q000150:complications; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001862:Bone Resorption / Q000517:prevention & control; D002116:Calcitonin / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D003657:Decision Making; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000150:complications / Q000209:etiology; D009942:Organometallic Compounds / Q000627:therapeutic use; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000517:prevention & control; D058866:Osteoporotic Fractures / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D053245:RANK Ligand / Q000037:antagonists & inhibitors; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D019379:Teriparatide / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use; D014808:Vitamin D Deficiency / Q000150:complications
D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; D009942:Organometallic Compounds; D053245:RANK Ligand; D020845:Selective Estrogen Receptor Modulators; D013876:Thiophenes; C081587:strontium ranelate; D019379:Teriparatide; D014807:Vitamin D; D000069448:Denosumab; D002116:Calcitonin