Pharmacological management of osteoporosis

Pharmacological interventions for the prevention of fractures in patients with osteoporosis aim mainly at correcting the bone remodelling imbalance by either reducing bone resorption and bone turnover, or stimulating bone formation. A number of agents are currently available but only a few were evaluated under controlled conditions in clinical trials whose primary efficacy end-point was the prevention of fractures. In addition, this information was obtained in patients with postmenopausal osteoporosis mainly with prevalent vertebral fractures, and most studies published to date had the occurrence of new vertebral rather than peripheral fractures as their primary efficacy end-point. The majority of data was obtained with inhibitors of bone turnover, but the level of evidence of the antifracture efficacy of these agents varies markedly. Results of carefully performed studies are, however, available allowing rational therapeutical choices. Adequate knowledge of the benefits and side effects of pharmacological interventions combined with other measures which improve bone health and reduce complaints and risks are essential for the management of the osteoporotic patient.