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[Therapeutic strategies in osteoporosis: whom and when to treat]
1Istituto di Semeiotica e Nefrologia Medica, Universitá degli Studi di Verona.
Abstract:
Postmenopausal bone loss can be efficiently prevented by compounds which inhibit bone resorption, but they can not induce a sustained and relevant bone gain. The initial increase in bone volume observed within the first year of treatment is due to a transient uncoupling between bone resorption and formation: the first is suddenly blocked whereas bone formation decreases slowly within several months; bone is gained until the previously resorbed cavities are refilled. This net increase in bone mass is completely lost as soon as treatment is withdrawn. Since these antiresorptive agents can only be used in order to prevent bone loss, they should be given for several years. Thus, the choice of the drug is also conditioned by its cost and long-term compliance. Estrogen replacement is very convenient, from these points of view in most patients immediately after the menopause. Afterwards, parenteral calcitonin has been, up to now, the sole available alternative with convincing evidence of effectiveness, at least in the medium term. Its cost and the scarce compliance to injections have strongly limited its extensive use. There is increasing evidence that oral bisphosphonates are very effective and therefore they might represent, in the near future, an effective and convenient alternative to estrogen replacement therapy.
Insights
Antiresorptive drugs prevent postmenopausal bone loss but do not significantly increase bone mass. Oral bisphosphonates show promise as a convenient and effective alternative for long-term osteoporosis management.
Area of Science:
- Endocrinology
- Bone Biology
- Pharmacology
Context:
- Postmenopausal osteoporosis is characterized by significant bone loss.
- Antiresorptive therapies are crucial for preventing further bone resorption.
- Current treatments primarily prevent loss rather than induce substantial bone gain.
Purpose:
- To evaluate the efficacy and convenience of different antiresorptive agents for managing postmenopausal bone loss.
- To compare estrogen replacement therapy, parenteral calcitonin, and oral bisphosphonates.
- To identify optimal long-term strategies for preventing osteoporosis progression.
Summary:
- Antiresorptive drugs effectively prevent bone loss by inhibiting resorption but do not achieve sustained bone gain.
- Initial bone volume increases due to transient uncoupling of resorption and formation, which is lost upon treatment cessation.
- Estrogen therapy is convenient, but parenteral calcitonin has limited compliance; oral bisphosphonates are emerging as effective and convenient alternatives.
Impact:
- Oral bisphosphonates may offer a cost-effective and convenient long-term alternative to estrogen replacement therapy for postmenopausal women.
- Improved drug selection can enhance patient compliance and long-term adherence to osteoporosis treatment.
- This research informs clinical practice regarding the management of postmenopausal bone loss and osteoporosis prevention.