[Fluorides and bisphosphonates in the treatment of osteoporosis]

The therapeutic aim in osteoporosis to maintain or increase bone mass can be achieved by inhibition of osteoclastic resorption (antiresorptive treatment), stimulation of osteoblastic formation (anabolic treatment), or a combination of both strategies. Antiresorptive therapy of osteoporosis with the nitrogen-containing bisphosphonates alendronate and risedronate is regarded today as evidence-based medicine. A significant reduction in the number of patients with new vertebral fractures has been documented already after 1 year. Anabolic therapy with fluoride was studied less extensively. The low price of fluoride salts and the lack of a patent protection may have contributed to this deficit in large studies. However, several recent medium-sized trials with a low-dose fluoride regimen consistently show a continuous increase in bone density and also a decrease in the rate of new fracture events. In our own pilot study with intermittent etidronate/fluoride therapy, we found significantly additive effects on bone mineral density. A larger trial with this therapeutic strategy using fractures as the primary endpoint would be of great interest.