Osteoporosis is now a treatable condition with an abundance of evidence for the efficacy of certain therapeutic strategies in preventing recurrent fractures. Most of these treatments act by improving bone mineral density through inhibition or reduction of bone resorption. For those women who are unable to take HRT; bisphosphonates, calcium, vitamin D, calcitriol or calcitonin may confer certain benefits. The bisphosphonate alendronate reduces both vertebral and long bone fractures, an effect seen soon after starting treatment. The changes in BMD and fracture reduction are less with the use of etidronate but it is certainly beneficial in reducing recurrent vertebral fracture. In the elderly calcium and vitamin D in combination can reduce non-vertebral and hip fracture and supplemental calcium of 1 g/day has been predicted to reduce bone loss and thus hip fractures by 22%.
Evidence that calcitriol or calcitonin reduce fracture incidence is not good but calcitonin has been shown to have analgesic properties in those with acute vertebral fracture. The role of calcitriol is less certain and should be reserved for women with vertebral fractures in whom HRT or bisphosphonates cannot be used.
. Consensus Development Conference: Diagnosis, Prophylaxis and Treatment of Osteoporosis. Am J Med1993; 94: 646–650.
2.
. KanisJAMeltonLJIIIChristiansenCJohnstonCCKhaltaevN.The diagnosis of osteoporosis. J Bone Miner Res1994; 9: 1137–1141.
3.
. Osteoporosis and its treatment. Drugs and Therapeutic Bulletin1984,; 22: 1–4.
4.
. SatoMGrasserWEnddNBisphosphonate action: Alendronate localisation in rat bone and effects on osteoclast ultrastructure. J Clin Invest1991; 88: 2095–2105.
5.
. FogelmanISmithLMazessRWilsonMABevanJAAbsorption of oral disphosphonate in normal subjects. Clin Endocrinol1986; 24: 57–62.
6.
. BoyceBFSmithLFogelmanIJohnstonERalstonSBoyleITFocal osteomalacia due to low-dose disphosphonate therapy in Paget's disease. Lancet1984; 1: 821–824.
7.
. WattsNBHarrisSTGenantHKIntermittent cyclical etidronate treatment of post-menopausal osteoporosis. N Engl J Med1990; 323: 73–79.
8.
. StormTThamsborgGSteinicheTGenantHKSorensenOHEffect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med1990; 322: 1265–1271.
9.
. StormT.KollerupGThamsborgGGenantHKSorensenOHFive years of clinical experience with intermittent cyclical etidronate for postmenopausal osteoporosis. J Rheumatol1996; 23: 1560–1564.
10.
. HarrisSTWattsNBJacksonRDFour year study of intermittent cyclic etidronate treatment of postmenopausal osteoporosis: Three years of blinded therapy followed by one year of open therapy. Am J Med1993; 95: 557–567.
11.
. MontessoriMLMScheeleWHNetelenbosJCKerkhoffJFBakkerK.The use of etidronate and calcium versus calcium alone in the treatment of postmenopausal osteopenia: Results of three years of treatment. Osteoporosis Int1997; 7: 52–58.
12.
. Van StaaTPAbenhaimLCooperC.Use of cyclical etidronate and prevention of non-vertebral fractures. Br J Rheumatol1998; 37: 87–94.
13.
. LinJHDugganDEChenI-WEllsworthRLPhysiological disposition of alendronate, a potent anti-osteolytic bisphosphonate, in laboratory animals. Drug Metab Disposit1991; 19: 926–932.
14.
. LibermanUAWeissSRBrollJEffect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med1995; 333: 1437–1443.
15.
. BlackDMCummingsSRKarpfDBRandomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet1996; 348: 1535–1541.
16.
. PolsHAPA multinational, placebo controlled study of alendronate in postmenopausal women with osteoporosis — results from the FOSIT study. J Bone Miner Res1997; 12S1: 172.
17.
. GertzBJHollandSDKlineWFStudies on the oral bioavailability of alendronate. Clin Pharmacol Ther1995; 58: 288–298.
18.
. Van StaaTAbenhaimLCooperC.Upper gastrointestinal adverse events and cyclical etidronate. Am J Med1997; 103: 462–467.
19.
. De GroenPCLubbeDFHirschLJEsophagitis associated with the use of alendronate. N Engl J Med1996; 335: 1016–1021.
20.
. DaviesMMawerEBHannJTTaylorJLSeasonal changes in the biochemical indices of vitamin D deficiency in the elderly. A comparison of people in residential homes, long stay wards and attending a day hospital. Age and Ageing1986; 15: 77–83.
21.
. Dawson-HughesB.HarrisSSKrallEADallalGEEffect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med1997; 337: 670–676.
22.
. ChapuyMCArlotMEDuboeufFVitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med1992; 327: 1637–1642.
23.
. LipsPGraafmansWCOomsMEBezemerPDBouterLMVitamin D supplementation and fracture incidence in elderly persons: a randomised placebo-controlled clinical trial. Ann Intern Med.1996; 124: 400–406.
24.
. HeikinheimoRJInkovaaraJAHarjuEJAnnual injection of vitamin D and fractures of aged bones. Calcif Tissue Int1992; 51: 105–110.
25.
. CummingRGNevittMCCalcium for the prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res1997; 12: 1321–1329.
26.
. ReidIRAmesRWEvansMCGambleGDSharpeSJEffects of calcium supplementation on bone loss in postmenopausal women. N Engl J Med1993; 328: 460–464.
. TilyardMWSpearsGFSThomsonJDoveyS.Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med1992; 326: 357–362.
29.
. RicoHRevillaMHernandezERTotal and regional bone mineral content and fracture rate in postmenopausal osteoporosis treated with salmon calcitonin: a prospective study. Calcif Tissue Int1995; 56: 181–185.
30.
. OvergaardKHansenMAJensenSBChristiansenC.Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis. Br Med J1992; 305: 556–561.
31.
. LyritisGTsakalakosNMagiasisBAnalgesic effect of salmon calcitonin in osteoporotic vertebral fractures: A double blind placebo controlled study. Calcif Tissue Int1991; 49: 369–372.
