title: Short-term and long-term effects of osteoporosis therapies.
abstract: Progress continues to be made in the development of therapeutics for fracture prevention. Bisphosphonates are now available orally and intravenously, often as inexpensive generics, and remain the most widely used interventions for osteoporosis. The major safety concern associated with the use of bisphosphonates is the development of femoral shaft stress fractures and, although rare, this adverse event affords the principal rationale for restricting bisphosphonate therapy to those individuals with femoral T-scores <-2.5, and for providing drug holidays in those individuals requiring therapy for >5 years. Newer antiresorptive therapies, in the form of denosumab and cathepsin K inhibitors, might increase efficacy and possibly circumvent some of the safety concerns associated with bisphosphonate use (for example, gastrointestinal and renal complications). The combination of teriparatide with antiresorptives markedly increases effects on BMD; new anabolic agents are also very promising in this regard. However, whether or not these changes in BMD translate into improved efficacy of fracture prevention remains to be determined. Vitamin D is important for the prevention of osteomalacia, but does not influence BMD or fracture risk in patients not deficient in vitamin D. The balance of risks and benefits of calcium supplementation is contentious, but patients should be encouraged to adhere to a balanced diet aimed at maintaining a healthy body weight. Consideration of a patient's risk of falling, and its mitigation, are also important. In this Review, I summarize the short-term and long-term effects of osteoporosis therapies.
authors.affiliation: Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Reid
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001713:Biphenyl Compounds / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D019485:Bone Morphogenetic Proteins / Q000037:antagonists & inhibitors; D002118:Calcium / Q000627:therapeutic use; D056657:Cathepsin K / Q000037:antagonists & inhibitors; D000069448:Denosumab / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D005819:Genetic Markers; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy* / Q000378:metabolism; D058866:Osteoporotic Fractures / Q000378:metabolism / Q000517:prevention & control*; D010281:Parathyroid Hormone / Q000627:therapeutic use; D013324:Strontium / Q000627:therapeutic use; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D000911:Antibodies, Monoclonal; D001713:Biphenyl Compounds; D050071:Bone Density Conservation Agents; D019485:Bone Morphogenetic Proteins; D004164:Diphosphonates; D004967:Estrogens; D005819:Genetic Markers; D010281:Parathyroid Hormone; C422903:SOST protein, human; D014807:Vitamin D; C557282:romosozumab; D000069448:Denosumab; D056657:Cathepsin K; C527128:odanacatib; D002118:Calcium; D013324:Strontium