Endocrine Abstracts

Osteoporosis has increasingly been recognised as a major healthcare problem. In the past diagnosis was predicated upon the results of bone density measurements with the WHO threshold of a T score of -2.5 being taken as diagnostic. This approach is being called into question as the importance of factors other than bone density upon the risk of fracture have emerged. It is likely that treatment for osteoporosis will soon be decided upon the basis of estimated fracture risk rather than bone density alone.

For many years HRT was the mainstay of treatment for postmenopausal osteoporosis. Given the increased knowledge regarding the risk-benefit ratio of this approach it is no longer considered to be first line therapy. It must be remembered that women who are receiving HRT for other reasons will be protected against osteoporosis and the risk of fracture.

The bisphosphonates are now seen as the first choice therapy for most causes of osteoporosis. They are generally well tolerated and parenteral dosing is being developed for those patients where gastrointestinal irritation is a problem. They appear to be safe for use up to 10 years but the ideal duration of therapy is unknown. NICE is shortly due to publish guidance on the use of these agents in the management of osteoporosis.

Raloxifene is less potent than the bisphosphonates but has the advantage of substantially reducing the risk of breast cancer.

Teriparatide (rhPTH1-34) is available as a daily subcutaneous injection. It is the first truly bone anabolic agent. As it is substantially more expensive than bisphosphonates it is likely that NICE will restrict its use to cases of bisphosphonate failure. However, there is evidence to suggest that it will be less effective in this situation.

Strontium Ranelate has recently been launched as the first of a class of bone active drugs which both stimulate formation and inhibit bone resorption.