[Therapeutic choices in osteoporosis]

Precise methods of evaluating bone density or bone quality (SPA, DPA, QCT, histomorphometry) have shown that various treatments for osteoporosis are efficient. Some drugs stimulate bone formation (NaF), others inhibit bone resorption (estrogens, calcitonin), while calcium and vitamin D act as additives. The drug is chosen which corrects the prevailing defect, which in turn can be suspected on the basis of a precise diagnosis. The latter is established by classification of the different forms of osteoporosis, based upon pathophysiological mechanisms. Apart from post-menopausal osteoporosis, which responds to estrogens, the other forms of high turnover osteoporosis may respond to calcitonin. Osteoporosis with low turnover, or age-related osteoporosis usually respond to NaF. Cyclic treatments set out to stimulate the maximum number of multicellular units of the bone. In this period of investigation and fruitful development, empiric treatment should give way to controlled cooperative studies.