Osteoporosis treatment: complexities and challenges

Excerpt

The analogy of cardiac events (e.g., myocardial infarction) and bone events (fractures) can inform our understanding of long-term management of osteoporosis. After a cardiac event, there is no hesitation in applying risk reduction actions, both pharmacologic and non-pharmacologic, whereas it is much less likely that a patient suffering a bone event will have any evaluation and treatment of underlying osteoporosis. This is compounded by the fact that osteoporosis is clinically silent before the fracture and after the fracture has healed, and by the fact that concerns about unusual side effects such as osteonecrosis of the jaw and atypical femoral fractures have led to fewer patients taking osteoporosis medications, particularly anti-resorptive agents [1]. The long-term impact of these phenomena is that while hip fracture incidence has decreased in postmenopausal women in developed countries, there will likely be a plateau followed by an increased incidence of fracture due to the aging of the population, the decrease in use of osteoporosis medications, and the rise of middle class populations in developing countries—people who will now live long enough to fracture. …