The main goal of osteoporosis treatment is the prevention of fractures.
Increases in bone density through the use of medications explain only a small proportion of the observed reduction in fracture risk. This suggests that agents that have some additional effects on bone quality to account for the reduction in fracture risk.
Important considerations in bone health include adequate intake of calcium and vitamin D, regular weight-bearing exercise, and avoidance of cigarette smoking and other negative factors.
Pharmacologic intervention is indicated for women who have T scores of -2.5 and below and for women with risk factors whose T scores are -1.5 or below.
Medications employed to treat osteoporosis include the bisphosphonates, calcitonin, selective estrogenreceptor modulators (SERMs), and parathyroid hormone.
Pharmacologic medications for the treatment of osteoporosis are classifi ed as either antiresorptive or anabolic agents. The only anabolic drug available currently is teriparatide (parathyroid hormone).
Bisphosphonates work through two broad mechanisms: They reduce the ability of individual osteoclasts to resorb bone and they accelerate osteoclast apoptosis (programmed cell death).
Calcitonin reduces bone resorption by binding to specifi c osteoclast receptors.
Selective estrogen-receptor modulators produce different expression of estrogen-regulated genes in different tissues, activating some and inhibiting others. The net effect of this is a reduction in bone resorption and possibly a reduction in the risk of breast cancer.
Teraparatide stimulates bone formation, producing gains in spine bone mineral density two to three times greater than those observed with antiresorptive drugs.
■ Bisphosphonates remain the first-line therapy for most patients, but teraparatide may be preferred for higher risk patients and for those failing to achieve a desired response to treatment with antiresorptive drugs.
KeywordsBone Mineral Density Vertebral Fracture Fracture Risk Parathyroid Hormone Zoledronic Acid
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