Over the last 25 years we have been expanding our choice of treatments for os oporosis. The chronic nature of the disease makes long term treatment necessary. It has long been known that long term management of osteoporosis suffers the same compliance problems as chronic treatment regimens for other disease like hypertension, hyperkolesterolemia, etc.
The most widely used treatment for osteoporosis is still oral bisphosphonates, which have come under increased scrutiny due to side effects like osteonecrosis of the jaw and atypical femoral fractures being linked to long term exposure. The available data suggest, however, that the risk of these adverse events in an osteoporosis population are extremely low. These events together with the unfounded fear of oversuppression of bone turnover during long term treatment with bisphosphoantes have elicited increased interest in drug holidays. The available data suggest that such holidays are possible, because bone turnover remains low many years, but in high risk individuals the risk of vertebral fractures increases. No significant increase in non vertebral fractures have been seen however.
Anabolic treatment with PTH for 2 years is necessary to exploit the full potential of the drug in terms of non-vertebral fracture reduction. Discontinuation of anabolic treatment should always be followed by an antiresorptive regimen, otherwise the bone gain is lost over a period of 2 years. Here the new long acting, parenteral regimens like Zoledronic acid and Denosumab seem expecially attractive.
30 Apr - 04 May 2011
European Society of Endocrinology