Management of osteoporosis
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 10
Abstract
Osteoporosis is a major neglected public health problem associated with significant morbidity and mortality. Treatment in a patient with osteoporosis is targeted at reducing the future fracture risk, which is achieved through a combination of non-pharmacological and pharmacological interventions. Education on simple measures aimed at fall prevention, and adequate calcium and vitamin D supplementation should be ensured in all patients treated for osteoporosis. Medications approved for treatment of osteoporosis include antiresorptive agents (estrogen, calcitonin, selective estrogen receptor modulator raloxifene, bisphosphonates and denosumab) and anabolic agents (teriparatide and abaloparatide). A search for newer treatment targets has enabled development of two new effective drugs-odanacatib and romosozumab. However, these drugs have not been approved due to increased risk of stroke and cardiovascular events seen in the study participants. At present, combination therapy with anabolic and antiresorptive agents is not recommended due to lack of data on antifracture efficacy and cost-effectiveness. The sequential therapy should comprise of anabolic agent first, followed by an antiresorptive agent to maintain the bone mineral density (BMD) gains achieved with the initial treatment. BMD should be monitored periodically and increasing (or maintained) areal BMD without incident fractures indicates successful treatment.
Authors and Affiliations
Alpesh Goyal, Nikhil Tandon
Keywords
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