title: Safety issues and adverse reactions with osteoporosis management.
abstract: BACKGROUND
  Osteoporosis is a disease that has spread worldwide and has become a relevant public health problem. Over the last 2 decades, a number of drugs have been licensed for its treatment owing to their efficacy in preventing fragility fractures. The safety profiles of these drugs are well defined with data from extensive programs of pharmacovigilance to support it.
  
  
  METHODS
  In this article we reviewed the long-term safety of Bisphosphonates, Calcium, Vitamin D, Selective Estrogen Receptor Modulators, Teriparatide and Denosumab. We excluded hormone replacement therapy that lost its indication for the treatment of osteoporosis. The license for the treatment of osteoporosis of Calcitonin was recently withdrawn and that of Strontium ranelate was severely limited. For both drugs, we report EMA statements about their safety profile.
  
  
  CONCLUSIONS
  The safety profile of most available drugs for the treatment of osteoporosis is well defined and the most serious adverse events are either rare or predictable. Osteoporosis treatment is a favorable choice in patients at moderate-high risk of fracture, while in patients at low risk pharmacological prevention should involve consideration of the balance between the beneficial effects of treatment, the probability of adverse effects and costs.
authors.affiliation: a Rheumatology Unit, Department of Medicine , University of Verona , Verona , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.affiliation: a Rheumatology Unit, Department of Medicine , University of Verona , Verona , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Adami
authors.affiliation: a Rheumatology Unit, Department of Medicine , University of Verona , Verona , Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.affiliation: a Rheumatology Unit, Department of Medicine , University of Verona , Verona , Italy.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Viapiana
authors.affiliation: a Rheumatology Unit, Department of Medicine , University of Verona , Verona , Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gatti
mesh_terms: D000818:Animals; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D014943:Global Health; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D060735:Pharmacovigilance; D011634:Public Health
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bisphosphonates; calcium; denosumab; selective estrogen receptor modulators; strontium ranelate; teriparatide; vitamin d