Treatment of osteoporosis: current and future

Article Abstract:

Several aspects of bone structure and metabolism must be understood before the problems of osteoporosis (bone thinning) can be appreciated. Normal bone is continually being remodeled, that is, old bone is resorbed and new bone is formed. In addition, some bones are not solid. Rather, trabeculae, a lace-like network of braces similar to the bracing seen in cathedral ceilings, provide support to bone, especially in long bones. In osteoporosis, remodelling is disturbed, and destruction of trabeculae occurs as well as bone loss. This results in a decrease in the mechanical strength of bone out of proportion to the weight of bone loss. Although preventive therapy aims to maintain bone mass, measurement of bone mineral (calcium content) density does not reflect changes in bone architecture. Decreased fracture rates reflect the effectiveness of medical intervention. The chief preventive strategy is estrogen replacement therapy, which reduces postmenopausal bone loss; greater effects are seen with larger doses. The hormone needs to be taken for 5 to 10 years to be most effective, and many patients may not be compliant with this protocol. Several medications are available for treating osteoporosis. Bisphosphonates, in general, work by inhibiting bone resorption, but they cause only a short-lived gain in bone mass as bone formation diminishes to match the resorption rate. Etidronate, a bisphosphonate, causes only a modest increase in bone mineral density, but reduces the rate of new vertebral fractures. Other bisphosphonates may have different activities over time, and these differences need to be identified. Decreased repair of fatigue fractures may occur after a few years of bisphosphonate therapy. Fluoride, which enhances bone formation, can increase bone mineral density in a year, but can cause marked side effects. It apparently fails to reduce vertebral fractures and may increase nonspinal fractures. Research is identifying new systemic hormones and other factors, such as aluminum salts, that regulate local bone production and function. Bone regulation is complex, and it is difficult to identify the best approaches, especially as side effects may accompany systemic agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Physiological aspects, Fluorides

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Prescribing by general practitioners after an osteoporotic fracture

Article Abstract:

Many older women do not receive appropriate medication after fracturing a bone from osteoporosis. Drugs which alter bone resorption can prevent fractures caused by the loss of bone density. Researchers compared the care of 300 elderly women in the year following an osteoporotic fracture with 300 similar women without a fracture history. There was a 37% increase in the use of bone drugs, such as etidronate, following vertebral fracture. There was no change in the use of such medications in women who had fractured their hip or wrist, although these drugs may prevent other fractures.

Care and treatment, Bones, Bone density, Fractures (Injuries), Fractures

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Current and potential future drug treatments for osteoporosis

Article Abstract:

There are several drugs currently available for treating osteoporosis and others may be available in the coming years. Estrogen, calcium, and vitamin D have been used effectively for managing osteoporosis. Estrogen therapy may, however, carry some risk for breast cancer and may be replaced in the future with an estrogen that specifically targets bone tissue. Other future treatment choices may include fluoride, risedronate, the biphosphonates, and drugs that stimulate bone growth and formation.

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