[Treatment and management of severe osteoporosis]

Because there is an extremely high probability of new fractures occurring in cases in which there are pre-existing fractures, it is easy for such patients to develop severe osteoporosis. We therefore must correctly ascertain any existence of either vertebral or hip fractures. High values of bone resorption markers reflect the existence of microfractures, so it is necessary to be careful due to the high risk of new fractures. Kinesitherapy for severe osteoporosis focuses on therapeutic exercise, walking, balance drills, and so forth with the aim of maintaining muscular strength and thus preventing falls. For severe osteoporosis such as senile osteoporosis and glucocorticoid-induced osteoporosis, bisphosphonates are currently the only medication that has been proven to be effective for preventing fractures. For the treatment of disuse osteoporosis stemming from paralysis, etc., the intravenous injection of bisphosphonates is able to suppress the decline in bone mass, but there is still very little evidence of its fracture prevention effect.