All about osteoporosis: Meeting the treatment challenge

The FDA-approved members of the antiresorptive class include bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid), calcitonin, estrogen replacement therapies, and raloxifene (a selective estrogen receptor modulator [SERM]) (Table). The oral bisphosphonates are approved for preven...

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Bibliographic Details
Published inThe Journal of musculoskeletal medicine Vol. 27; no. 5; p. 181
Main Authors Davis, Stacy, Sachdeva, Alok, Goeckeritz, Bruce, Oliver, Alyce
Format Journal Article
LanguageEnglish
Published Darien MultiMedia Healthcare Inc 01.05.2010
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Summary:The FDA-approved members of the antiresorptive class include bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid), calcitonin, estrogen replacement therapies, and raloxifene (a selective estrogen receptor modulator [SERM]) (Table). The oral bisphosphonates are approved for prevention and management of postmenopausal osteoporosis in women, for osteoporosis in men, and for corticosteroid-induced osteoporosis. Monitoring a patient's treatment progress and determining the appropriate time to terminate therapy are important. The International Society for Clinical Densitometry recommends follow-up BMD testing (dual-energy x-ray absorptiometry [DXA] of the spine and hip) when the expected change in BMD equals or exceeds the least significant change (LSC); this typically occurs 1 or 2 years after the start of or a change in therapy, but the intervals between DXA measurements are longer once therapeutic effect is established.10 When factors that are associated with rapid bone loss (eg, corticosteroid therapy) are present, more frequent testing is appropriate.3 The BMD, bone marker, and fracture data in the women who continued alendronate for 10 years were similar to the data in those who did not. In the women who were switched to placebo after 5 years of alendronate therapy, there was a gradual decline in BMD, but mean BMD remained at or higher than levels 10 years earlier. There also was a gradual rise in biochemical markers of bone turnover. In the placebo groups, the rate of nonvertebral fracture or morphometry vertebral fractures, detected by lateral spine radiographs, was not significantly different from that in the alendronate group. However, there was a slightly higher risk of clinically detected vertebral fracture. There were no differences in adverse events between the groups. The authors concluded that stopping alendronate therapy after 5 years results in a gradual decline in BMD and an increase in biochemical markers of bone turnover but no significantly higher risk of fracture (except for clinical vertebral fracture).
ISSN:0899-2517