Current options for the treatment of osteoporosis

Authors: V. Vyskočil
Authors‘ workplace: Osteocentrum FN Plzeň, II. interní kliniky LF UK a FN Plzeň, přednosta prof. MUDr. Jan Filipovský, CSc., a Traumacentra Kliniky ortopedie a traumatologie pohybového ústrojí, přednosta prof. MUDr. Karel Koudela, CSc.
Published in: Vnitř Lék 2010; 56(7): 749-758
Category: 80th Birthday - Jaroslava Blahoše, MD, DrSc.


The primary aim of osteoporosis treatment is prevention of osteoporotic fractures. The main factors in the development of these fractures are mechanic resistance of the bone and the bone quality. The importance of risk factor identification increases and it is important to consider the structural analysis of the hip-bone when evaluating and deciding whether to prescribe antiresorptive or osteoanabolic drugs or whether to just modify calcium and vitamin D intake. Various options are currently available for the pharmacological treatment of osteoporosis: calcium and vitamin D supplementation together with aminobisphosphonates, or osteoanabolic treatment with parathormone derivatives; monoclonal antibody to RANKL denosumab will also soon become available.

Key words:
osteoporosis – BMD – risk of fractures – FRAX – DXA – HAS software – calcium – vitamin D – alendronate – risedronate – ibandronate – zoledronate – calcitonin – strontium ranelate – parathormone derivatives – denosumab


1. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis and Therapy. Osteoporosis prevention, diagnosis and therapy. JAMA 2001; 285: 785–795.

2. Black D, Nguyen ND, Milch VE et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009; 301: 513–521.

3. Kanis JA, McCloskey EV, Johansson H et al. National Osteoporosis Guideline Group. Case finding for the management of osteoporosis with FRAX – assessment and intervention thresholds for the UK. Osteoporos Int 2008; 19: 1395–1408.

4. Recker R, Hinders S, Davies KM et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 1996; 11: 1961–1966.

5. Fait T, Vokrouhlická J, Vrablík M et al. Současné postavení hormonální substituční terapie. Čas Lék Čes 2004; 143: 447–452.

6. Black DM, Thompson DE, Bauer DC et al. Fracture Intervention Trial. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J Clin Endocrinol Metab 2000; 85: 4118–4124.

7. Harris ST, Watts NB, Genant HK et al. Effects of risendronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risendronate Therapy (VERT) Study Group. JAMA 1999; 282: 1344–1352.

8. McClung MR, Geusens P, Miller PD et al. Hip Intervention Program Study Group. Effect of risendronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001; 344: 333–340.

9. Eriksen EF, Hodgson SF, Eastell R et al. Cancellous bone remodeling in type I (postmenopausal osteoporosis: quantitative assessment of rates of formation, resorption, ad bone loss t tissue and cellular levels. J Bone Miner Res 1990; 5: 311–319.

10. Arlot ME, Delmas PD, Chappard D et al. Trabecular and endocortical bone remodeling in postmenopausal osteoporosis: comparison with normal postmenopausal women. Osteoporos Int 1990; 1: 41–49.

11. Seeman E, Hopper JL, Bach LA et al. Reduced bone mass in the daughters of women with osteoporosis. N Engl J Med 1989; 320: 554–558.

12. Duan Y, Turner CH, Kim BT et al. Sexual dimorphism in vertebral fragility is more the result of gender differences in age‑related bone gain than bone loss. J Bone Miner Res 2001; 16: 2267–2275.

13. Miller PD, Christiansen C, Hoeck HC et al. Efficacy of bazedoxifene for prevention of osteoporosis: results of a 2‑year, phase III, placebo and active controlled study. J Bone Miner Res 2007; 22 (Suppl 1): S559.

14. Russell RG, Watts NB, Ebetino FH et al. Mechanism of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 2008; 19: 733–759.

15. Black DM, Delmas PD, Eastell R et al. HORIZON Pivotal Fracture Trial. Once‑yearly zolendronic acid for treatment of postmenopausal osteoporosis. N Eng J Med 2007; 356: 1809–1822.

16. Bone HG, Hosking D, Devogelaer JP et al. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Eng J Med 2004; 350: 189–1199.

17. Zikán V. Nové možnosti farmakologické léčby osteoporózy na obzoru. Postgrad Med 2008; 10 (Suppl): 52–58.

18. Mehta N, Ray V, Stern B et al. Clinical development of recombinant oral calcitonin. Osteoporos Int 2009; 20 (Suppl 1): 103.

19. Dobnig H, Turner RT. Evidence that intermittent treatment with parathyroid hormone increases bone formation in adult rats by activation of bone lining cells. Endokrinology 1995; 136: 3632–3638.

20. Palička V, Živný P, Pavlíková L. Léčba postmenopauzální osteoporózy – novinky v principech i postupech. Medicína po promoci 2009; 10: 81–87.

21. Chapuy MC, Arlot ME, Duboeuf F et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Eng J Med 1992; 327: 1637–1642.

22. Lips P, Graafmans WC, Ooms ME et al. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 1996; 124: 400–406.

23. Barrett-Connor E, Cauley JA, Kulkarni PM et al. Risk‑benefit profile for raloxifene: 4‑year data from the Multiple Outcomes of Raloxifen Evaluation (MORE) randomized trial. J Bone Miner Res 2004; 19: 1270–1275.

24. Barrett-Connor E, Grady D, Sashegyi A et al. Raloxifene and cardiovascular events in osteoporotic postmenopausal women. Four‑year results from the MORE randomized trial. JAMA 2002; 287: 847–857.

25. Fink HA, Ensrud KE, Nelson DB et al. Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT). Osteoporos Int 2003; 14: 69–76.

26. Delmas PD, Recker RR, Chesnut CH 3rd et al. Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study. Osteoporos Int 2004; 15: 792–798.

27. Miller PD, McClung MR, Macovei L et al. Monthly oral ibandronate therapy in postmenopausal osteoporosis: 1‑year results from the MOBILE study. J Bone Miner Res 2005; 20: 1315–1322.

28. Reginster JY, Adami S, Lakatos P et al. Efficacy and tolerability of once-monthly oral ibandronate in postmenopausal osteoporosis: 2 year results from the MOBILE study. Ann Rheum Dis 2006; 65: 654–661.

29. Vyskočil V. Stroncium ranelát v léčbě osteoporózy. Farmakoterapie 2005; 5: 425–457.

30. Vyskočil V. Osteoporóza a ostatní nejčastější metabolická onemocnění skeletu. Praha: Galén 2009.

31. Michalská D. Nové poznatky o léčbě osteoporózy. Interní Med 2009; 11: 498–501.

32. Pluijm SMF, Smit JH, Tromp AM et al. Identifying community-dwelling elderly at high risk for recurrent falling. Results of a three year prospective study. In: Pluijm SMF. Predictors and Consequences of Falls and Fractures in the Elderly (PhD Thesis). Enschede: Ipskamp, 2001: 91–108.

33. Siris ES, Chen YT, Abbott TA et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 2004; 164: 1108–1112.

34. Kurland ES, Cosman F, McMahon DJ at al. Parathyroid hormone as a therapy for idiopathic Osteoporosis in men: effects on bone mineral density and bone markers. J Clin Endocrinol Metab 2000; 85: 3069–3076.

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