Stratification of treatment of postmenopausal osteoporosis

Overview

Despite a statistically proven efficacy of aminobisphosphonates (risedronate and alendronate)in preventing fractures of the proximal femur, their effect only applies to elderly osteoporoticpatients who already suffered a fracture. In women under to who already suffered an osteoporoticfracture, all available antiresorptive drugs (raloxifene, calcitonin, risedronate and alendronate)are capable of decreasing the risk of vertebral fracture. The magnitude of this effectafter 4-5 years therapy using all the above-mentioned drugs is similar, even though differentmechanisms are exerted. Raloxifene, risedronate and alendronate all demonstrably decreasethe vertebral fracture risk associated with postmenopausal osteoporosis in women without anyprevious fracture. Only raloxifene demonstrably decreases fracture risk in women with osteopeniaof the proximal femur. The above-mentioned antiresorptive drugsmeet the requirementsfor successful long-term osteoporosis treatment to a varyiing degree. They differ in efficacy(fracture risk reduction), degree of bone quality improvement, beneficial effects on tissues otherthan bone and acceptable risk of long-term side effects. All of these criteria are prerequisite forlong-term compliance and adherence to treatment. They should applied prior to treatmentinitiation in patients with postmenopausal osteoporosis considering their age, individualfracture risk within the next 5-10 years and other health conditions.

Key words:
osteoporosis - bisphosphonates - raloxifene - teriparatide - fracture.