Endocrine Abstracts

The fractures that result from postmenopausal osteoporosis have a major public health impact. We have a number of drugs we can use to reduce the risk of these fractures. Most of these drugs are anti-resorptive, such as the bisphosphonates (alendronate, ibandronate, risedronate and zoledronate), raloxifene, oestrogen, and denosumab. Until recently the only anabolic agent available was teriparatide. However, in the last couple of years two new agents have been approved in some countries, namely abaloparatide (an analogue of parathyroid hormone related protein) and romosozumab (an antibody against sclerostin). Important questions arise such as should the anabolic drugs be given early in the course of osteoporosis or just to patients with severe disease? What treatment should be given after these anabolic treatments? The anti-resorptive drugs are very safe. However, it has become common practice to take ‘drug holidays’ in patients taking bisphosphonates for 3–5 years in order to prevent rare side effects such as atypical femur fracture. Thus, the indications for treatment, the order of treatment and the individualisation of treatment are all important considerations for optimal patient care. We highlighted these issues in a recent guideline from the Endocrine Society1, endorsed by the European Society for Endocrinology.

Reference

1. Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH & Shoback D. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism 2019 104 1595–622.