Treatment of bone in elderly subjects: calcium, vitamin D, fluor, bisphosphonates, calcitonin

Several approaches may be suggested for prevention or treatment of senile osteoporosis. In elderly patients, an association of calcium and vitamin D supplementation has been shown to reduce nonvertebral fractures up to 40% over an 18-month period. Calcitonin, given parenterally or nasally, may prevent further bone loss and has been reported to significantly decrease vertebral and hip fractures. This hormone also possesses an important analgesic effect. Fluoride salts are the most effective way to significantly increase bone mass, mainly at the trabecular site. The optimal doses and regimens remain to be clearly established. The use of new formulations like sodium monofluorophosphate are likely to facilitate the search of the optimal therapeutic window. Bisphosphonates are potent inhibitors of bone resorption. They have been shown to significantly increase trabecular bone mass without impairment of cortical bone. Their use may be associated with a significant decrease in vertebral fractures, mainly in patients with severe osteoporosis. The new, second and third generation of bisphosphonates (tiludronate, risedronate, alendronate) look extremely promising but their widespread use will only be possible after a confirmation of the absence of a deleterious effect on bone quality (alendronate) and after demonstration of a reduction in vertebral and/or hip fractures following a prolonged use.