Treatment of patients with postmenopausal osteoporosis is worthwhile. The position of the International Osteoporosis Foundation

Excerpt

Although many agents have been used in the treatment of osteoporosis, only in the past 10 years have large, double-blind placebo-controlled trials been published on postmenopausal women with the condition of using incident fractures as the primary endpoint. Several agents have been proven to significantly decrease the risk of vertebral and, in some instances, long bone fractures [1]. Tables 1 and 2 show the anti-fracture efficacy of the most commonly used agents for which large fracture trials are available, i.e., the bisphosphonates alendronate and risedronate, the selective estrogen receptor modulator (SERM) raloxifene, the 1–34 fragment of recombinant human parathyroid hormone (teriparatide), and to some extent nasal calcitonin. These agents have consistently shown a substantial reduction of the risk of vertebral fracture ranging from 30–65% according to agent and patient populations. A significant reduction of the risk of nonvertebral fractures has been shown with alendronate and risedronate, ranging from 16–36% according to studies, and with teriparatide (53% reduction). Table 2 shows the effect of treatments on hip fracture risk in populations of decreasing risk from top to bottom. Indeed, hip fracture risk is highly dependent on age, and most studies performed in osteoporotic women younger than 75 years do not have the statistical power to demonstrate an effect of any agent on hip fracture incidence. A decrease in the risk of nonvertebral fractures, including hip, has been shown in the elderly, especially among institutionalized men and women treated with calcium and vitamin D supplementation [1]. That supplementation, however, cannot be considered a sufficient treatment of established osteoporosis, as it is included in the active treatment and placebo groups of most trials. Etidronate has been shown to decrease vertebral—but not nonvertebral—fracture risk, and it has been superseded by newer more potent bisphosphonates. Vitamin D metabolites and the vitamin K menatetrenone have been shown in some small studies to decrease the risk of fragility fractures, but the evidence is still limited [1]. Finally, anti-fracture efficacy has been recently shown with a new bisphosphonate, ibandronate [2] and with strontium ranelate [3], but these agents are not yet widely available. Despite these significant advances in the field of osteoporosis there is still uncertainty over the question of whom to treat. Healthcare agencies differ markedly in the indications for treatment so that authoritative guidance is needed. …