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PubMed2004

The burden of osteoporosis in Latin America.

Osteoporosis causes considerable morbidity, mortality and resource utilization in industrialized nations. Its burden is relatively well known in United States and Canada, but poorly studied in the rest of America. This study aimed to discover the burden of osteoporosis in Latin America through a review of literature and publicly available information. In this transversal and descriptive study, information from 20 countries in Latin American region was collected from diverse published and electronic sources. Rheumatologists and bone specialists were asked for additional information through a questionnaire created by consensus. In the year 2000, the population of the Latin America and Caribbean region was 524 million from diverse ethnic origins. On average, 5.5% of the population is 65 years and older. However, with life expectancy higher than 70 years in most countries, a significant growth in the elderly population is anticipated. Studies using World Health Organization's criteria for osteoporosis report 12-18% of women 50 years and older with vertebral osteoporosis and 8-22% with proximal femur osteoporosis. Community based studies in Argentina reported between 263 and 331 hip fractures per 100,000 people 50 years and older. Hospital based studies in Colombia, Chile, Brazil, Mexico, Panama, Peru and Venezuela reported between 40 and 362 hip fractures per 100,000 persons aged 50 and more. Between 17 and 37% of hip fracture sufferers die in the year following fracture. Prevalence of vertebral fractures in community-dwelling women aged 50 and more in Mexico is 19.35%. Data on other fractures are rare. Direct costs of a hip fracture ranged from $4500 to $6000. National gross income per capita in the region ranges from $410 to $7550. The burden of osteoporosis varies across countries with differences in populations and health resources. Considerable support for research is required, since numerous gaps in knowledge need to be filled to face the anticipated explosive growth in osteoporotic fractures.

Aged↗
PubMed2006

Determinants of adherence to osteoporosis treatment in clinical practice.

INTRODUCTION: Poor adherence to prescribed treatments is widespread in clinical practice and this can lead to potentially life-threatening events. This problem is apparently very common for osteoporosis treatment but the causes of discontinuation and low compliance are complex and poorly defined. METHODS: Global adherence to osteoporosis treatment was specifically addressed in a nation-wide survey carried out in 9851 postmenopausal women referred to 141 Italian centres for osteoporosis management for a follow-up assessment, at least one year after having been prescribed a treatment with one of the following drugs: calcium+/-vitamin D supplements alone (CaVitD), hormone replacement therapy (HRT), raloxifene 60 mg (RLX), intramuscular clodronate 100 mg/7-14 days (CLOD), risedronate 5 mg/day (RIS) and alendronate 10mg/daily (ALN10) or 70 mg once weekly (ALN OW). RESULTS: Overall 19.1% of the patients discontinued the prescribed drug before attending the bone mass re-evaluations, more than half of them within the first 6 months. The discontinuation rate was significantly different between the treatments. The medications most frequently interrupted within one year were CLOD (28.7%; p<0.01 versus any other treatment), while by far the least interrupted was ALN-OW (6.9%; p<0.001 versus any other treatment). The most frequent reasons for discontinuation were drug related side effects, insufficient motivation to treatment and fear of side effects. The prevalence of the reasons for discontinuation were different among treatments: safety concerns were very common for HRT, lack of motivation was the most common cause for CaVitD and CLOD, and drug related side effects for RIS, ALN and RLX. Persistence to treatment was significantly higher in patients with previous vertebral fractures, densitometric osteoporosis, on corticosteroid or anti-inflammatory treatments. A significantly increased risk of treatment interruption was found among patients on benzodiazepine or gastro-protective agents and in patients in whom a bone measurement was not readily available. The highest compliance to recommended dosing was observed with ALN OW and HRT (p<0.001 versus any other) and the lowest for CaVitD (p<0.01 versus any other). Poor treatment compliance (<50% drug taken) was significantly related to benzodiazepine and gastroprotective use, while a significantly better compliance was associated with recognized risk factors for osteoporosis: early menopause, low bone mass values values, previous vertebral fractures. The poorest adherence was observed when treatments were prescribed by General practitioners (GPs), and orthopaedic surgeons (p<0.01 versus global mean). CONCLUSIONS: The results of this large survey of Italian osteoporotic women indicates that the most important determinant of both persistence and compliance to treatment is the type of drug prescribed with a definite advantage of ALN-OW. Treatment compliance is particularly poor for CaVitD and this emphasizes the need for new ways to supplement at least vitamin D. The main reasons for discontinuation are side effects and lack of motivation while the best treatment adherence was observed in patients with severe and well documented osteoporosis.

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PubMed2002

Osteoporosis in elderly: prevention and treatment.

Osteoporosis is a major clinical problem in older women and men. Almost any bone can fracture as a result of the increased bone fragility of osteoporosis. These fractures are associated with higher health care costs, physical disability, impaired quality of life, and increased mortality. Because the incidence of osteoporotic fracture increases with advancing age, measures to diagnose and prevent osteoporosis and its complications assume a major public health concern. BMD is a valuable tool to identify patients at risk for fracture, to make therapeutic decisions, and to monitor therapy. Several other modifiable and nonmodifiable risk factors for osteoporosis have also been identified. Treatment of potentially modifiable risk factors along with exercise and calcium and vitamin D supplementation forms an important adjunct to pharmacologic management of osteoporosis. Improved household safety can reduce the risk of falls. Hip protectors have been found to be effective in nursing home population. The pharmacologic options include bisphosphonates, HRT, SERMs and calcitonin. PTH had received FDA advisory committee approval. Alendronate has been approved for treatment of osteoporosis in men, and other treatments for men are under evaluation.

Aged↗
PubMed2003

Osteoporosis prevention: knowledge and behavior in a southwestern community.

Prior to developing an osteoporosis prevention education program and social marketing campaign, we sought to (a) establish current status of osteoporosis-related knowledge and behavior among women aged 25-55 years in Maricopa County, Arizona, and (b) assess factors that segment the population by age and ethnicity. Two-hundred women were surveyed by telephone using random-digit dialing selection. Data demonstrated knowledge of need to consume adequate calcium, but mixed understanding of forms of exercise that help prevent osteoporosis. Knowledge of osteoporosis prevention did not differ as a function of menopause status. Differences for Hispanic versus non-Hispanic women's knowledge showed fewer correct responses for Hispanics for dietary and physical activity questions, and more correct responses on the relationship between body weight and osteoporosis risk. Hispanic women and post-menopausal women generally fit the pattern of higher risk behaviors with Hispanic women exercising and using HRT less and postmenopausal women reporting lower calcium intake and physical activity and more tobacco use. Hispanic women appeared to have similar intake of dietary calcium despite lower levels of milk products. Social marketing campaigns for osteoporosis prevention should be segmented for cultural and age differences, especially considering differences in orientations toward exercise, milk consumption, and competing emphasis on other diseases.

Adult↗
PubMed2002

Oral radiographic predictors of osteoporosis.

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of the bone scaffold that result in increased bone fragility and susceptibility to fracture. It is one of the most common disorders of the elderly and is estimated to effect 75 million people in Europe, Japan and the USA. The purpose of screening for osteoporosis is to identify individuals who are likely to benefit from treatment. The fact that dental radiographs are regularly made on a large fraction of the adult population makes their potential use as a marker of skeletal health an exciting avenue of research. In the last four decades numerous research teams have reported oral radiographic findings associated with osteoporosis. The preponderance of the evidence shows that the jaws of subjects with osteoporosis show reduced bone mass and altered morphology. Clinically useful predictions of individuals most likely to develop osteoporotic fractures will require a multifactorial model including both radiographic and clinical findings. Future efforts should continue to search for oral radiographic signs with high sensitivity and specificity for osteoporosis, identify clinical signs available in the dental office associated with osteoporosis, develop multidisciplinary classification methods including both radiographic and clinical parameters, and automate radiographic and clinical analyses as much as possible to minimize the involvement of the dentist as well as to standardize data collection.

Absorptiometry, Photon↗
PubMed2026

Association between anaemia and osteoporosis: a systematic review and meta-analysis.

BACKGROUND: Osteoporosis significantly impacts global morbidity. Recent evidence suggests anaemia may contribute to osteoporosis risk. This systematic review and meta-analysis investigates this association. METHODS: PubMed, Scopus, EBSCO, and ScienceDirect were searched for papers. Studies with definition of anaemia and assessing osteoporosis outcomes were included. Meta-analysis utilized random-effects models (DerSimonian-Laird method), and study quality was assessed via Newcastle-Ottawa Scale (NOS). Analyses were performed using R Studio. RESULT: Eighteen studies (861,540 participants) were analyzed. Anaemia significantly increased osteoporosis risk in univariate analysis (OR 1.62; 95% CI 1.33-1.98; p&#x2009;<&#x2009;0.001), despite high heterogeneity (I2 = 92.7%). The results remain significant in studies that reported multivariate analysis (OR 2.01; 95% CI 1.26-3.21; p&#x2009;=&#x2009;0.004). Sensitivity analyses confirmed the robustness of our result. CONCLUSION: Anaemia significantly associated with osteoporosis, emphasizing the need for targeted screening in anaemic individuals. Further studies should consider incorporating anaemia into osteoporosis and fracture prediction tools.

Humans↗
PubMed2004

An ongoing six-year innovative osteoporosis disease management program: challenges and success in an IPA physician group environment.

The goal of this ongoing comprehensive osteoporosis disease management initiative is to provide the adult primary care physicians' (PCPs) offices with a program enabling them to systematically identify and manage their population for osteoporosis. For over six years, Hill Physicians Medical Group (Hill Physicians) has implemented multiple strategies to develop a best practice for identifying and treating members who were candidates for osteoporosis therapy. Numerous tools were used to support this disease management effort, including: evidence-based clinical practice guidelines, patient education sessions, the Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire tool, member specific reports for PCPs, targeted member mailings, office-based Peripheral Instantaneous X-ray Imaging (PIXI) test and counseling, dual x-ray absorptiometry (DEXA) scan guidelines, and web-based Electronic Simple Calculated Osteoporosis Risk Estimation (eSCORE) questionnaire tools. Hill Physicians tabulated results for patients who completed 2649 SCORE tests, screened 978 patients with PIXI tests, and identified 338 osteopenic and 124 osteoporotic patients. The preliminary results of this unique six-year ongoing educational initiative are slow but promising. New physician offices express interest in participating and those offices that have participated in the program continue to screen for osteoporosis. Hill Physicians' message is consistent and is communicated to the physicians repeatedly in different ways in accordance with the principles of educational outreach. Physicians who have conducted the program have positive feedback from their patients and office staff and have begun to communicate their experience to their peers.

Absorptiometry, Photon↗
PubMed2000

Osteoporosis: epidemiology, diagnosis, and treatment.

Osteoporosis is an important health problem in the United States affecting approximately 24 million Americans, 15 to 20 million of whom are women over 45 years of age. Bone fractures are the major cause of morbidity and mortality associated with osteoporosis. The most common fractures are those of the forearm, hip, and vertebral body, as well as the humerus, tibia, pelvis, and ribs. Osteoporosis-related injuries result in complications leading to prolonged hospitalization, decreased independence, increased incidence of depression, and a reduced quality of life. The disease takes an enormous personal and economic toll, with estimated costs in excess of $13.8 billion annually for direct medical treatment. The incidence of osteoporosis-related fractures is increasing and constitutes a major public health problem in the United States. With a few preventive measures such as identification of risk factors, careful examination, and a few simple diagnostic tests, prevention of osteoporosis during the teen and early adult years is far superior to any treatment for older individuals. Osteoporosis can be identified and an appropriate treatment strategy can be determined.

Female↗
PubMed1994

Comparison of changes in bone mineral in idiopathic and secondary osteoporosis following therapy with cyclical disodium etidronate and high dose calcium supplementation.

OBJECTIVE: Our clinical practice has been to offer treatment with cyclical disodium etidronate and high dose calcium supplements (1500-1600 mg/day) to all female patients with osteoporosis who are unable or unwilling to take hormone replacement therapy (HRT), and male osteoporotics. In a retrospective study we compared the effect of this treatment on measures of bone mineral over a 12-month period in women with post-menopausal and secondary osteoporosis. We also assessed its effects in 10 male osteoporotics. DESIGN: A retrospective analysis of 83 consecutive patients with osteoporosis who completed 12 months of treatment with disodium etidronate and calcium and who had a dual energy X-ray absorptiometry (DEXA) scan at baseline and following 12 months of therapy. PATIENTS: The study included 73 women (45 post-menopausal and 28 secondary osteoporotics) and 10 men with established osteoporosis as shown by spinal and femoral bone mineral densities (BMD) > 2 standard deviations (SD) below young normals, and radiological evidence of osteoporosis. MEASUREMENTS: Each patient had routine biochemistry at baseline, an X-ray of thoracic and lumbar spine and a DEXA scan of lumbar spine (L2-L4) and femoral neck. The DEXA scan was repeated following 12 months of therapy. RESULTS: There was no difference between increase in spinal BMD in the post-menopausal (5.7%) versus secondary osteoporotic group (6.7%). There was a significant increase in spinal BMD at 12 months in the 10 male osteoporotics (9.0%, P < 0.01). No overall change in femoral neck BMD was noted. CONCLUSIONS: Cyclical disodium etidronate given with high dose calcium supplements is equally effective in increasing spinal bone mineral density in post-menopausal and secondary osteoporosis. It also results in a significant rise in spinal bone mineral density in male osteoporotics. Whether this produces a reduction in fracture rates is unknown.

Bone Density↗
PubMed2004

Non-response to osteoporosis treatment.

There are now a number of effective treatments for osteoporosis, which increase bone mineral density (BMD) and decrease the risk of fractures. There is no clear consensus on the optimal method for assessing response to treatment in the individual patient. The goal of osteoporosis treatment is to prevent fractures after minimal trauma, but these are relatively uncommon events and cannot be totally avoided by the use of currently available therapies. Alternative methods of assessing response to treatment include serial measurement of BMD or the biochemical markers of bone turnover, but the observed changes may be misleading if they do not exceed the least significant change. The proportion of patients who fail to respond to osteoporosis treatments is difficult to quantify. Clinical trials show continuing bone loss in up to 15% of participants on hormone replacement therapy or bisphosphonates. Non-response to treatment is probably more common in clinical practice, but may be due to poor adherence to treatment recommendations. Other potential causes of an apparent failure to respond to treatment include the use of a weak antiresorptive agent, differences in bioavailability, low dietary calcium intake, vitamin D insufficiency and underlying causes of secondary osteoporosis. The management of patients who fail to respond to treatment includes confirmation that they are adhering to treatment and have an adequate dietary calcium intake and vitamin D status and excluding causes of secondary osteoporosis. Consideration should also be given to the addition of calcium and vitamin D supplementation and the use of alternative treatments for osteoporosis.

Age Factors↗
PubMed2006

Anabolic skeletal therapy for osteoporosis.

Antiresorptive agents for osteoporosis are a cornerstone of therapy, but anabolic drugs have recently widened our therapeutic options. By directly stimulating bone formation, anabolic agents reduce fracture incidence by improving bone qualities besides increasing bone mass. In this article, we review the role of anabolic treatment for osteoporosis. The only anabolic agent currently approved in the United States for osteoporosis, teriparatide [recombinant human parathyroid hormone(1-34)], has clearly emerged as a major approach to selected patients with osteoporosis. Teriparatide increases bone density and bone turnover, improves microarchitecture, and changes bone size. The incidence of vertebral and nonvertebral fractures is reduced. Teriparatide is approved for both postmenopausal women and men with osteoporosis who are at high risk for fracture. Other potential anabolic therapies for osteoporosis, including other forms of parathyroid hormone, strontium ranelate, growth hormone, and insulin-like growth factor-1, are also reviewed in this article.

Bone Density↗
PubMedDate not supplied

[Resource utilization and costs in osteoporosis].

BACKGROUND: Osteoporosis is characterized by low bone mass, deterioration of the microarchitecture of the bone tissue and increase susceptibility to fractures. Clinical manifestations are fractures and their complications. The most common fractures are hip,spine and wrist, although any bone is susceptible. OBJECTIVES: To assess the resource utilization and the annual costs incurred by patients with postmenopausal osteoporosis METHODS: One hundred consecutive patients were studied in the Universidade Federal de São Paulo. The inclusion criteria were: postmenopausal osteoporosis (WHO 1994) for at least one year b) at least one year attending the outpatient clinic, minimal comprehensive and speaking conditions. The socioeconomic and clinical characteristics, the resource utilization and costs in the last year were assessed using 2 questionnaires. The unitary costs were based in the Public Healthcare System Index (1998). RESULTS: The mean age was 66 years and the monthly family income was R$ 534.14 (US$ 456 - in 1998). There was a mean of 7 visits/patient/ year. 77% of the patients used calcium and 38% used estrogens. The mean total annual costs for osteoporosis treatment, considering societal perspective, were R$ 908.18 (US$ 776-in 1998) per patient per year. CONCLUSION: The costs related to osteoporosis treatment represented 11% of the mean monthly household income from the patients' perspective (R$ 534=US$ 456). As the population is ageing and the osteoporosis incidence is increasing, health policy should be implemented to rationally allocate the scarce resources available, based on economic analysis.

Aged↗
PubMed2002

Improvement in the undertreatment of osteoporosis following hip fracture.

BACKGROUND: Osteoporosis is a common disease characterized by decreased bone mass and increased fracture risk in postmenopausal women and the elderly. Hip fractures are among the most common consequences of osteoporosis and unfortunately usually occur late in the course of the disease. When a patient is admitted to the hospital with a fragility hip fracture, a unique opportunity for diagnosis and treatment presents itself. Fortunately, several medications have proven to be effective in lowering the risk of future fractures. The purposes of the present study were to test the hypothesis that most fragility hip fractures go untreated and to determine whether educational efforts to raise physician awareness have led to an improvement in osteoporosis treatment rates. METHODS: A retrospective cohort study was performed with use of the patient databases at two university medical centers and one university-affiliated community hospital. The charts of 300 randomly selected patients were sorted with use of ICD-9 (International Classification of Diseases, Ninth Revision) codes for femoral neck fractures. There were 100 patients from each center, with twenty-five patients from each year between 1997 and 2000. The admitting diagnosis, mechanism of injury, admission medications, procedures performed during hospitalization, and discharge medications were then extracted and analyzed. During this period, the National Osteoporosis Foundation established guiding principles for the treatment of fragility fractures. RESULTS: Of the seventy-five patients from all centers for each year from 1997 to 2000, 11%, 13%, 24%, and 29%, respectively, were discharged with a prescription for some medication targeting osteopenia, either supplemental calcium or an antiosteoporotic medication (estrogen, calcitonin, a bisphosphonate, or raloxifene). A trended chi-square analysis of this increase revealed a p value of <0.001, indicating that this improvement in treatment was unlikely due to chance alone. Fifty-eight (19.3%) of the 300 patients in the study received a prescription at the time of discharge. However, forty of these patients (13.3% of the overall group) received calcium and only eighteen (6.0% of the overall group) received a medication to actively prevent bone resorption and treat osteoporosis. In addition, no patient underwent a bone density scan while in the hospital. CONCLUSIONS: Elderly patients and postmenopausal women who are admitted to the hospital and diagnosed with a low-energy femoral neck fracture have been undertreated for osteoporosis. However, over the four years of the present study, there was a significant increase in the rate of treatment. It is hoped that treatment rates will continue to increase in the future with continued educational efforts.

Aged↗
PubMed1999

Managing elderly people's osteoporosis. Why? Who? How?

OBJECTIVE: To guide family physicians through assessment of why treating elderly people's osteoporosis is necessary, who to treat, and how to treat in a practical way. QUALITY OF EVIDENCE: Evidence of the efficacy of treatment for osteoporosis is shown by a reduced probability of fracture. This can be ascertained by direct evaluation for bisphosphonates, calcium, and calcitonin, or indirectly by ascertaining benefit to bone mineral density for hormone replacement therapy (HRT) and exercise. MAIN MESSAGE: Unless medically contraindicated, all elderly people should take supplementary vitamin D (800 IU/d) and calcium (1500 mg/d). Those with risk factors for osteoporosis (e.g., smoking, thinness, previous fracture when older than 50 years, fracture in first-degree relatives older than 50 years, and steroid use) should have a bone density measurement. Those meeting World Health Organization criteria for osteoporosis should also be treated with HRT or bisphosphonates or possibly with selective estrogen receptor modulators. CONCLUSIONS: Good evidence indicates that adequate treatment of osteoporosis can prevent fractures and thus reduce associated morbidity and mortality among vulnerable elderly people. Because of the prevalence of osteoporosis, the onus falls on family physicians to be the front-line managers.

Aged↗
PubMed2001

[Osteoporosis and Colles' fracture].

We describe the connection between osteoporosis and Colles' fractures of the distal radius from an epidemiological and aetiological point of view. In addition, the value of these fractures as markers of osteoporosis and future risk of fracture is assessed. Several studies have clearly shown an epidemiological association between osteoporosis and fractures of the distal radius, with the association strongest for women up to 65 years of age and for osteoporosis located in the forearm. The association weakens for other locations and for older women. Osteoporosis may have some aetiologic significance for the development of Colles' fractures, but several extraskeletal factors are of equal or further importance. The occurrence of a Colles' fracture in the first 10-15 years after the postmenopause indicates an increased relative risk of sustaining another fracture in the future. However the relative risk approaches one after a few years and, because of the comparatively low absolute risk in this age-group, Colles' fracture as a risk factor contributes little to an assessment of the lifetime fracture risk. In a few longitudinal studies, Colles' fractures could not predict the long-term risk of osteoporosis. The presence of a Colles' fracture should lead to considerations concerning the skeletal and extraskeletal causes of the fracture for the purpose of initiating preventive and therapeutic measures.

Adult↗
PubMed2003

[Genetic background of osteoporosis].

Osteoporosis is characterized by a decrease in bone mass as well as a deterioration of the bone architecture resulting in an increased risk of fracture. The disease is multifactorial, and it depends on environmental and genetic factors. Twin studies have shown that genetic factors account for 60-80% of the variance in bone mineral density, the best predictor of the risk of osteoporosis. There are different approaches to identify these genetic factors. Linkage studies in human and experimental animals have defined multiple loci that regulate bone mass but most of the genes responsible for this effect remain to be defined. The 11q12-13 locus was the first that was linked to bone mineral density of the young female and special bone diseases like high bone mass syndrome and osteoporosis-pseudoglioma syndrome. Both diseases appear to be in association with LDL receptor-related protein 5 gene mutation. The effect of LDL receptor-related protein 5 on bone metabolism had not been known only genetic methods suggested it. The effect of LRP5 in osteoporosis pathogenesis requires more investigation. Association and linkage studies have been performed in order to identify candidate genes in the pathogenesis of osteoporosis. Vitamin D receptor gene was the first candidate, however its effect is controversial. Other candidates, such as insulin like growth factor, interleukin-6, estrogen receptor alpha, transforming growth factor beta show no or small effect on bone mineral density or fracture frequency. To date only Sp1 polymorphism of collagen gene seems to have a consistent effect on bone fragility. The improved understanding of osteoporosis genetics should lead to better diagnosis of this disease and new treatment and prevention strategies.

Animals↗
PubMed2005

Osteoporosis risk factors in rural and urban women from the Lublin Region of Poland.

In various epidemiological and clinical studies, bone quality, bone mineral density (BMD), as well as risk of falling have been associated with lifestyle and anthropometric/demographic characteristics. The objective of this study was to evaluate the osteoporosis risk factors occurrence and its association with BMD in rural and urban women from the Lublin Region in Poland. A cross-sectional study of risk factors of osteoporosis and fracture was carried out in a cohort of 900 rural and urban women aged 30-79 years, representative of the general population the Lublin Region. Data pertaining to osteoporosis risk factors as well as medical history were taken using a specially designed 31 item questionnaire divided in seven sections: social history, past medical history, reproductive history, drug history, family history of osteoporosis, nutritional habits and lifestyle factors. The lumbar spine (L(2)-L(4)) was examined in a-p position using the dual X-ray absorptiometry- DXA (LUNAR Corp.). The differences between urban and rural women in the appearance of particular osteoporosis risk factors, such as gynecological, dietary calcium intake, smoking and coffee consumption, was noticeable. Age, years of menopause and family history of osteoporosis (in mothers) were found to have strong negative independent associations with lumbar spine BMD. Body Mass Index (BMI) was found to have strong positive association with BMD. Dietary calcium intake, coffee consumption and level of physical activity had noticeable positive and independent, but not significant association with BMD.

Absorptiometry, Photon↗
PubMed2006

[Pharmacotherapy of osteoporosis: evidence-based clinical practice].

Since the foundation of the DVO ("Dachverband Osteologie") in 1999, it has been the continuous ambition to implement evidence-based medicine in the clinical course for the effective diagnosis and treatment of osteoporosis. This aim was addressed by the implementation of general guidelines (DVO) in 2003. These guidelines (DVO) offer strategies for diagnosis and treatment of osteoporosis in postmenopausal women, osteoporosis in elderly women and glucocorticoid-induced osteoporosis. Evidence-based treatment of osteoporosis recommends the supplementation with calcium and vitamin D, considering antiresorptive therapy antifracture efficacy is proven for the bisphosphonates alendronate, ibandronate and risedronate on the one hand and the SERM raloxifen on the other hand. On the basis of valid data from randomized, placebo-controlled clinical trials, new therapy regimen like rhPTH1-34 (teriparatide) or strontium ranelate fulfill the recommendation criteria for the guidelines (DVO). Effective treatment of glucocorticoid-induced osteoporosis includes supplemental calcium and vitamin D and antiresorptive agents like the bisphosphonates alendronate, risedronate and etidronate according to the guidelines (DVO).

Adult↗