Endocrine Abstracts

Osteoporosis affects more than 75 million people in Europe, United States and Japan, and more than 4.5 million osteoporotic fractures occur in Europe and United States. The aim of treating osteoporosis is to reduce risk of fractures and to improve quality of life of patients with preexisting fractures. Several interventions to prevent and reduce fracture risk are being recommended. These include adequate intake of calcium (at least 1000 mg per day), vitamin D (at least 800 mg per day), muscle strengthening, exercise, avoiding nicotine, alcohol and other osteoporosis risk factors and treating disorders leading to osteoporosis.

The most commonly used osteoporotic drugs are antiresorptives. They include bisphosphonates (alendronate, risedronate, ibandronate used orally weekly or monthly and ibandronate used also intravenously yearly), selective estrogen receptor modulators (raloxifene), calcitonine and in the past also hormone replacement therapy (because of higher risk of cardiovascular events and breast cancer used sporadically). Teriparatide and parathormone are osteoanabolic drugs and strontium ralenate has dual antiresorptive and osteoanabolic effect. All these drugs have shown to reduce risk of vertebral and some also nonvertebral fractures.

Indication for most of the drugs (except teriparatide and parathormone, which have special prescription criteria) is in Europe T score <−2.5 S.D. and a osteoporotic fracture. Lately WHO developed a FRAX algorithm, which allows to estimate 10 year fracture probability and to individualize the treatment selection for each patient. For monitoring the treatment bone mineral density and bone turnover are used. The average duration recommended for the treatment is 5 years, in osteoanabolics 18 months.

Early onset of powerful treatment can now effectively reduce the number of osteoporotic fractures.