Editorial

Osteoporosis Treatment in 2005

Authors: Robert A. Adler, MD

Abstract

In the detailed review1 by Hamdy et al, it is clear that there are many choices for osteoporosis therapy. Although ibandronate is appealing because of the availability of monthly dosing and teriparatide is potentially a good choice for the drug naïve patient at very high fracture risk, two oral bisphosphonates, alendronate and risedronate, remain the mainstays of therapy for most patients. There are likely small differences between them, and there are plenty of papers to argue for one or the other. The question is, how much does it matter? If, from the Fosamax Actonel Comparison Trial,2 alendronate increases bone density more and decreases bone turnover markers more, does this mean it lowers fracture risk more? There are studies3 to show that after a given suppression of bone turnover markers, there is no further vertebral fracture reduction. However, there are also studies4 showing greater fracture risk reduction with greater bone turnover marker suppression or greater increases in bone mineral density.5

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References

1.Hamdy RC, Chestnut CHIII, Gass ML, et al. Review of treatment modalities for postmenopausal osteoporosis. Southern Med J 2005;98:1000–1014.
 
2.Rosen CJ, Hochberg MC, Bonnick SL, et al. Treatment with once-weekly alendronate 70 mg compared with once-weekly risedronate 35 mg in women with postmenopausal osteoporosis: a randomized double-blind study. J Bone Miner Res 2005;20:141–151.
 
3.Eastell R, Barton I, Hannon RA, et al. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 2003;18:1051–1056.
 
4.Bauer DC, Black DM, Garnero P, et al. Change in bone turnover and hip, nonspine, and vertebral fracture in alendronate-treated women: The Fracture Intervention Trial. J Bone Miner Res 2004;19:1250–1258.
 
5.Hochberg MC, Ross PD, Black D, et al. Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis. Fracture Intervention Trial Research Group. Arthritis Rheum. 1999;1246–1254.
 
6.Kanis JA, Johnell O, Oden A, et al. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporosis Int 2001;12:989–995.
 
7.Raisz LG. Screening for osteoporosis. N Engl J Med 2005;353:164–171.
 
8.Harrington JT, Broy SB, Derosa AM, et al. Hip fracture patients are not treated for osteoporosis: a call to action. Arthritis Rheum 2002;47:651–654.
 
9.Adler RA, Hochberg MC. Suggested guidelines for evaluation and treatment of glucocorticoid-induced osteoporosis for the Department of Veterans Affairs. Arch Intern Med 2003;163:2619–2624.
 
10.Van Staa TP, Leufkens HG, Abenhaim L, et al. Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000;15:993–1000.
 
11.Boonen S, McClung MR, Eastell R, et al. Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: implications for the use of antiresorptive agents in the old and oldest old. J Am Geriatr Soc 2004;52:1832–1839.
 
12.Newman ED, Ayoub WT, Starkey RH, et al. Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years.Osteoporosis Int 2003;14:146–151.