[Osteoporosis and fractures: a review of current therapies]

The authors examine the effects of different drugs used in osteoporosis therapy for the primary and secondary prevention of fractures. They base their review on prospective randomized studies; retrospective studies are included only if a consistent number of subjects has been examined. Their methodological characteristics are illustrated, and results with significant levels and 95% confidence intervals are reported. Only hormone replacement therapy and salmon calcitonin have been demonstrated as able to prevent vertebral and non-vertebral fractures. Vitamin D and its analogues seem to be effective only in elderly patients, although conclusive data are lacking. With regard to bisphosphonates, only data on vertebral fractures are presently available. Results from fluoride studies are still very inconclusive, and, in fact, lead to the hypothesis of a fracture-promoting effect. At present, no data on ipriflavone are available. Considerably more research is necessary to define the efficacy of different treatment protocols for fracture prevention. Each therapeutic proposal for osteoporosis should be supported by data on its efficacy in reducing the incidence of fractures. Not always, in fact, is an absolute increase of bone mass followed by the effective prevention of fractures. At this time, only estrogens and calcitonin have been demonstrated as able to reduce fracture incidence.