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PubMed1995

Treatment of osteoporosis in elderly women.

Prevention of osteoporosis is better than cure. This intuitive wisdom is strengthened by knowledge that osteoporosis due to gonadal deficiency is associated with a disruption of skeletal architecture that is irreversible by current treatments. Moreover, it is commonly assumed that bone is lost more slowly in later life than in the several years after the menopause, so that factors other than decreasing bone mass are assumed to be of greater importance for fracture risk. With the exception of fluoride, current treatments have not been shown to restore skeletal mass in patients with osteoporosis. These views have suggested that the management of osteoporosis in the elderly is of limited value and have reinforced the importance of preventive measures. Notwithstanding, there are several reasons for believing that intervention late in the natural history of bone loss is worthwhile. Whereas cross-sectional studies suggest that bone loss declines in later years, prospective studies indicate that bone loss is progressive and indeed accelerates in extreme old age. Moreover, the measurement of bone mass predicts future fracture in the elderly as effectively as it does at the time of the menopause. There are also several reasons why preventive approaches at the time of the menopause have limited applicability. Since current preventive treatments cannot be given indefinitely, a crucial question concerns the extent to which reversal of effect occurs after treatment withdrawal. If catch-up bone loss does occur, it decreases markedly the cost-effectiveness of therapeutic intervention at the menopause and provides a convincing rationale for the use of interventions at a much later age. The optimum age for starting treatment is not yet determined but might be best directed 15 or so years after the menopause, well before the mean age of hip fracture. Since hip fracture provides the greatest socioeconomic impact of osteoporosis and since evidence is accumulating that treatments favorably affect hip fracture risk, it is suggested that greater attention should be given to the management of osteoporosis in the elderly.

Age Distribution↗

PubMed1995

[Histomorphometric study of osteoporosis in rheumatoid arthritis].

A histomorphometric study of osteoporosis in rheumatoid arthritis was performed on thirty-eight specimens from the proximal tibial metaphysis, which were obtained during total knee arthroplasty. Fourteen specimens from the proximal tibial metaphysis of osteoarthritis patients were also histomorphometrically studied, and the osteoporosis in rheumatoid arthritis was compared with it in osteoarthritis. In nine rheumatoid arthritis patients, specimens from the iliac bone were obtained, and the difference between the generalized osteoporosis and the juxta-articular osteoporosis was evaluated. The proximal tibial metaphysis in rheumatoid arthritis was usually represented by a fairly low bone area and by thin mean trabecular thickness. No correlations were seen between histomorphometric parameters and the age at operation, the age of onset and the duration of disease. However, in patients of long duration (over 20 years), the bone area was very low and mean trabecular thickness was thin. In one parameter (scalloped surface) which shows bone resorption, there was a high correlation between generalized osteoporosis and juxta-articular osteoporosis in rheumatoid arthritis. There was no significant difference between rheumatoid arthritis and osteoarthritis in bone area and mean trabecular thickness. However, the scalloped surface of rheumatoid arthritis was significantly higher than it of osteoarthritis.

Adolescent↗

PubMed1995

[Contribution of osteo-densitometry in the definition and diagnosis of osteoporosis].

Since its first characterisation, osteoporosis has always been defined on an anatomical basis. The term osteoporosis refers to a reduction (or atrophy) in the amount of bone tissue and to microarchitectural deterioration without any mineralisation defect. Its clinical significance lies in the fractures (vertebral fracture, Colles' fracture and hip fracture) that occur spontaneously or after a minimal trauma. During the past 15 years, developments in technology of bone mass measurement (osteodensitometry) currently allow a diagnosis of osteoporosis at its anatomical stage characterised by a reduction in bone mass (osteopenia) without any symptom. A definition based on densitometry offers the major advantage of an early diagnosis, well before the development of fractures. It has been validated recently by several prospective studies which have confirmed the close relationship between the decrease in bone mass and the fracture risk. This modern densitometric approach of osteoporosis has major therapeutic implications. Indications of curative treatments of osteoporosis has major therapeutic implications. Indications of curative treatments of osteoporosis should be reconsidered according to the contribution of bone densitometry.

Absorptiometry, Photon↗

PubMed1994

[Therapeutic concepts in the treatment of postmenopausal osteoporosis].

Postmenopausal osteoporosis is not a well-defined disease, but summarizes women with different severity of changes in bone metabolism and different clinical complaints. The only common feature in women with 'postmenopausal osteoporosis' is the deficiency of estrogen. Postmenopausal women can be subdivided into four groups, according to their risk for fractures: 1. women without evident increase of fracture risk (bone mineral content between 0 and 2 SD of age-related normal range, no known risk factors from history); 2. women with possible increase of fracture risk (bone mineral content between 0 and -2 SD of age-related normal range, with or without known risk factors from history); 3. women with clear increase of fracture risk (bone mineral content below age-related normal range, with or without known risk factors from history); 4. women with already occurred fracture (manifest osteoporosis). Therapeutic intervention in postmenopausal women should be adapted to the risk for fracture. In all four groups a secondary prevention or basic therapy should be performed, focusing on calcium intake, vitamin D supply and sufficient physical activity. Calcium intake should be 1500 mg/day in women without estrogen substitution and 1000 mg in women with estrogen substitution. In patients living mainly inside or with malnutrition, a daily substitution of 500 E. Vitamin D3 is recommended. In group 2, regular control of bone mass is recommended to start additional estrogen replacement therapy, if accelerated loss of bone mass occurs. In group 3, estrogen replacement therapy is recommended urgently and is the therapy of first choice to prevent development of fractures. In group 4 (manifest osteoporosis), therapy should aim on improvement of the patient's symptoms and on increase of bone stability to avoid further fractures. The symptomatic therapy includes pain medications and an intensive physical therapy adapted to the patient's needs. Physical therapy should be performed for long time to reduce complaints and to improve musculoskeletal function in order to prevent falls. Different agents influencing bone metabolism by inhibition of bone resorption (estrogens, calcitonin, bisphosphonates) or stimulation of bone formation (fluoride) are used in manifest osteoporosis to increase bone stability. But the present efficacy to avoid further fractures has not been shown sufficiently for all available agents, so that a final evaluation and recommendation can't be done. Therapy decisions in manifest osteoporosis are often influenced by the possible side effects of the drugs (bleeding, gastrointestinal problems, joint pain), other, not bone-related effects of the drugs (improvement of climacteric complaints, pain relief) and other concomitant diseases and medications.

Aged↗

PubMed1994

[Treatment of osteoporosis: current data and prospects].

Postmenopausal osteoporosis is characterized not only by a reduction in bone mass but also by bone microarchitecture alterations, which result in greater bone frailty and in an increased fracture risk. Many drugs have been studied to determine whether they prevent bone loss or reduce the incidence of additional fractures in patients with established osteoporosis. Primary prevention of osteoporosis rests on regular exercising and adequate intake of dietary calcium. For secondary prevention in women undergoing menopause, replacement estrogen therapy given for at least ten years is associated with substantial reductions in fractures of the radius, hip, and spine. Other drugs capable of arresting postmenopausal bone loss include parenteral, nasal or rectal calcitonin and diphosphonates. However, the long-term safety of the latter requires further evaluation. Current studies are evaluating new molecules with potential preventive efficacy, such as ipriflavone. There is no general consensus about the efficacy of treatments for established osteoporosis with fractures. To date, no controlled studies have demonstrated a reduction in the incidence of further fractures in patients given calcium alone. Studies of hydroxylated vitamin D derivatives have been disappointing, although daily administration of vitamin D3 in combination with calcium significantly reduced the incidence of nonvertebral fractures in a population of elderly institutionalized subjects. Plausible explanations for this effect include increased vitamin D levels and reduced parathyroid levels in the bloodstream. Parenteral or nasal calcitonin stabilizes or increases bone mineral content in both cancellous and cortical bone. This effect is especially marked in high-turn-over patients. Several lines of evidence suggest that calcitonin therapy has a protective effect against vertebral and hip fractures. In patients with osteoporosis, oral or intravenous diphosphonates are associated with a significant increase in cancellous bone mass with no loss of cortical bone. Etidronate may be especially beneficial in severe osteoporosis with marked loss of bone and multiple vertebral crush fractures. Fluoride stimulates the growth and synthetic activity of osteoblasts. Accurate information is needed on the optimal dosage of fluoride, on the effects of fluoride on the appendicular skeleton, and, above all, on the biomechanical properties of the bone produced under fluoride therapy. In addition to these commercially available drugs, several other agents are at various stages of the development process.(ABSTRACT TRUNCATED AT 400 WORDS)

Calcitonin↗

PubMed1993

[Prevalence and risk factors of osteoporosis in a population sample of Szczecin residents over 50 years of age].

The prevalence of osteoporosis and risk factors were evaluated in the random sample of Szczecin population aged over 50 years. Five hundred five individuals (273 women and 232 men) were examined. Risk factors for osteoporosis were evaluated with the aid of an questionnaire. Two X-ray pictures of both thoracic and lumbar spine were taken in the lateral position in all examined subjects and evaluated for osteoporosis. The most frequently encountered risk factors included: low physical activity (60% of women and 50% of men), tobacco smoking (43% of women and 79% of men), low consumption of the diary products in adolescence (53% of women and 49% of men), history of bone fractures, early menopause, and diabetes mellitus. The interpretation of X-ray findings showed that the incidence of osteoporosis was increasing with the age in both sexes, and was considerably higher in women. An analysis of the relationship between risk factors and radiological diagnosis of osteoporosis with chi 2 test showed that significantly higher incidence of the disease in women was associated with long-term immobilization, low milk consumption, tobacco smoking, and early menopause. Osteoporosis in men correlated with only tobacco smoking.

Aged↗

PubMed1996

[Osteoporosis in ankylosing spondylitis].

Bone formation is classically observed in ankylosing spondylitis, but osteoporosis can also occur. This condition has been recognized for years on radiographs. Compared with controls, osteoporosis in ankylosing spondylitis is responsible for increasing the incidence of vertebral compression fractures and also explains spinal fractures after trauma, mainly observed at the cervical level. Measurement of bone mass is useful in diagnosing osteoporosis commonly observed in the lumbar spine and the femoral neck but not in the appendicular skeleton. Osteoporosis is seen early in the disease whereas increased bone mass is observed later or due to syndesmophyte formation. Osteoporosis in ankylosing spondylitis is probably a multi-factorial condition. Contributing factors are spine immobility secondary to ankylosis, inflammatory cytokines which enhance bone resorption, prolonged use of nonsteroidal antiinflammatory drugs and a deficit in sex hormone secretion. Furthermore, there is no alteration in calcium or phosphorus metabolism in ankylosing spondylitis. Finally, a study of bone morphometrics in the iliac crest region is required to better explain osteoporosis in ankylosing spondylitis.

Absorptiometry, Photon↗

PubMed1996

[Osteoporosis: assessment, prevention and treatment in Danish departments of orthopedic surgery].

Questionnaires were sent to all departments of orthopaedic surgery in Denmark and all departments of general surgery that treat patients with fractures in order to examine: A) whether patients with osteoporosis are identified, B) whether such patients are treated for osteoporosis, and C) whether doctors need more information about osteoporosis. Fifty-six departments (97%) returned the questionnaires. Eighty-eight percent of the departments do not refer the patients with low-energy fractures to bone mineral densitometry. Only 18% of the departments make further evaluations of patients with possible osteoporosis. Eleven percent of the departments treat patients with a low-energy fracture for osteoporosis. The medication used was typically vitamin tablets combined with calcium. One department used oestrogens and none used bisphosphonates. About half of the departments advised the patients about changes in their lifestyle, and half of the departments wanted more information about osteoporosis. In conclusion, few Danish departments with orthopaedic surgery functions evaluate and treat the cause of the fractures.

Bone Density↗

PubMedDate not supplied

Osteoporosis in India--the nutritional hypothesis.

Osteoporosis, a silently progressing metabolic bone disease that leads to loss of bone mass, is widely prevalent in India and osteoporotic fractures are a common cause of morbidity and mortality in adult Indian men and women. This review of the international patterns of osteoporosis reveals two distinctive clinical features of this disease in Indians. Firstly, hip fractures occur at a relatively earlier age in Indian males and females, compared to their western counterparts; and secondly, a higher male-to-female ratio suggests that Indian males are at a higher risk for hip fractures. The reasons for these differences are not known. It is possible that a dietary deficiency of calcium, beginning early in life, leads to a lower peak bone mass, and consequently osteoporosis at an earlier age. Furthermore, malabsorption of calcium due to a subclinical deficiency of vitamin D may lead to osteoporosis, without causing osteomalacia. With the increase in life expectancy, osteoporosis has become a formidable public health problem in India and a multidisciplinary approach is needed to identify its aetiological factors and devise strategies for mass prevention of calcium and vitamin D deficiency (possibly by fortification of food with these nutrients). Another issue that needs to be addressed is the social dogma against hormone replacement therapy in postmenopausal women. These measures, coupled with health education of the masses, should help promote bone health and control osteoporosis in India.

Aged↗

PubMed1997

[Evaluation of the prevalence of osteoporosis in a population of women living in Krakow based on densitometric measurements of the forearm].

Osteoporosis is considered a civilization disease, affecting populations living in big cities. It is detected in 10 percent of population and in 30 percent women over fifty. We tried to estimate prevalence of osteoporosis in people living in Kraków. For estimation purposes, 1000 people living in Kraków more than 40 years were chosen. 325 persons came to our Department for examination, 232 of which were women. All patient filled a special questionnaire on pathological changes in skeletal system and risk factor of osteoporosis. Densitometric measurements of nondominant forearm using Osteometer DTX 100 were performed in all patients. For osteoporosis criteria level of T-score less than -2.5 was taken. Because of lack of Polish reference data for densitometric measurements our data were compared to WHO data, concerning prevalence of osteoporosis in white women. Compared to WHO data, a higher frequency of osteoporosis was found in women living in Kraków more than 40 years.

Adult↗

PubMed1998

[Epidemiology of osteoporosis: incidence, prevalence, and prognosis].

Though the exact and cumulative incidence of osteoporosis has not been examined, using the criteria that osteoporosis is defined by a decrease of bone mineral density (BMD) below 70% from young adult mean (YAM), the prevalence of osteoporosis among the Japanese women can be estimated as to be more than either 30% (by spinal BMD) or 37% (by femoral BMD) in 60's, 37% or 64% in 70's, and 42% or 90% in 80's, respectively. The total number of osteoporosis among the women with age 50 and over can be also estimated as to be either about 5 million (by spinal BMD) or 8.5 million (by forearm BMD). National survey shows that the ratio of people receiving treatment for osteoporosis is 34.5 per 1,000 among the elderly with age 65 and over. In addition, both functional transition and survival rate of discharged patients with osteoporotic hip fracture are discussed as prognosis of osteoporosis.

Adult↗

PubMed1998

[Osteoporosis in rheumatoid arthritis].

Patients with rheumatoid arthritis (RA) develop both periarticular and generalized osteoporosis. Periarticular osteopenia in appendicular bones occurs early in the course of RA and is one of the earliest radiological signs of RA. An uncoupled state in bone resorption-formation linkage, contributes to the development of periarticular osteopenia and it might be mediated through an increased productions of cytokines and prostaglandins by synovium and bone marrow. Accordingly, early suppression of rheumatoid synovitis is necessary for the prevention of periarticular osteopenia. Generalized osteoporosis is also common in RA and leads to increased risk of fractures. Generalized osteoporosis considered to be multifactorial and factors contributing to lumbar osteoporosis might be different from those to loss of appendicular bones, such as femur and radius. Corticosteroids and menopausal state are important risk factors for lumbar osteoporosis. Rheumatoid activity and reduced physical activity are also important determinants. According to the previous studies, however, the influence of functional impairment is more prominent in the femoral BMD compared to spinal BMD. In addition to control of RA and maintenance of physical activity, hormone replacement therapy (HRT) and bisphosphonate are possible agents for the treatment of osteoporosis in RA patients, especially postmenopausal women.

Arthritis, Rheumatoid↗

PubMed1997

[Changes of calcitonin reserve function in patients with primary osteoporosis].

In order to study the role of calcitonin (CT) in osteoporosis, the calcium loading calcitonin stimulated test (calcium element 3 mg/kg body weight, i.v., 10 min) was used to investigate calcitonin reserve function in 21 women with osteoporosis. The sesults were compared with those in 48 healthy women and 7 women with osteopenia. After calcium infusion, there was no significant difference in the basal CT, the peak CT value, the CT increase range, and the area under the curve (AUC) between pre- and post-menopausal healthy women. In patients with primary osteoporosis, the four parameters were significantly lower than those in normal controls, and the CT peak value and increase range were lower than those in patients with osteopenia. In the osteopenia group, the basal CT value and its AUC were lower than those in the age-matched control group, but no difference was found in the peak CT value and the increase range between the two groups. The results showed no evident effect of menopause on calcitonin reserve function, but suggested a possible relationship between the decrease of CT reserve function and osteoporosis in patients with osteoporosis. Calcitonin deficiency has something to do with the development of osteoporosis.

Aged↗

PubMed1976

[Patterns of localization and process in age induced bone atrophy and pathological osteoporosis (author's transl)].

Dennert and Münzenberg recommend comparative examination of x-rays of the spine and coxal end of the femur both for the differentiation of physiological bone atrophy and pathological osteoporosis and for the gradual evaluation of osteoporosis. The systematic bone deterioration in the proximal section of the femur in physiological osteoporosis is absent in the pathological forms of osteoporosis where only the skleletal trunk is usually involved. Since quantitative examination procedures for the exact differenciation of osteoporosis are generally not available for the practice, the comparative examination represents an essential help for diagnosis and the gradual evaluation of osteoporosis. To support the interpretation of the findings from this procedure which is well suited for the practice, the chronological and local process of physiological and pathological osteoporoses (obtained by quantitative radiological measurements) are compared.

Adult↗

PubMed2004

Experimentally induced prolonged magnesium deficiency causes osteoporosis in the rat.

Background: It has been shown that prolonged daily peroral magnesium (Mg) administration, as tabs of Mg(OH)(2), used as the only treatment in postmenopausal osteoporosis, causes a significant increase in BMD. Objective: In order to obtain definitive evidence of causality of magnesium deficiency in the etiology of osteoporosis, we spent 1 year examining rats given a daily Mg-deficient diet (200 ppm) and compared them with rats given a Mg-adequate diet (2000 ppm). Methods: Sixteen female Sprague-Dawley rats, mean weight 110 (S.D. 23) g, were divided into two groups and randomly assigned to a semisynthetic diet that differed only in Mg content. Urine samples were collected every 3 months and blood was collected at the end of the trial. After the animals were sacrificed, the L3-L5 vertebrae and the femoral regions were examined for bone density (BMD) using dual energy X-ray absorptiometry. The femoral bones were examined for bone fragility and the tibiae by histomorphometry, and the mineral content of the bones was estimated. Results: The mean BMD of L3-L5 vertebral bone was significantly higher in group A (adequately nourished) than in the Mg-deficient group B (p=0.035, one-tail); in addition, the BMD of the femural region was significantly higher in group A (p=0.045, one-tail). The bending stiffness of the femur was slightly higher in group A than in group B; however, after correction to diminish the influence of the difference in bone dimensions between the two groups, femur rigidity (i.e., the loss of elasticity) in group B became significantly higher than that in group A (p=0.024). The force needed to break the bone was significantly higher in group A than in group B (p=0.024) and it remained higher after correction, although no longer significantly. In group B, the diminution of the trabecular bone volume, in relation to tissue volume (BV/TV), and the increase in the degree of trabecular interconnection (TBPf) clearly showed the presence of osteoporosis. On microscopy, focal osteoporosis of the metaphyseal spongious bone was observed in the bone rendered Mg-deficient. Conclusions: Because osteoporosis is characterized by lowering of BMD, increased bone fragility, and altered bone architecture, our study showed that maintaining rats for 1 year on a Mg-deficient diet gives rise to the appearance of osteoporosis.

Journal Article↗

PubMed1998

Prevalence of osteoporosis in women referred for bone density testing: utility of multiple skeletal sites.

The objective of this study was to determine retrospectively the prevalence of osteoporosis in a referral population and to compare the effectiveness of measuring multiple skeletal sites for identifying osteoporosis. Although osteoporosis is considered to be a major public health problem in the United States, and there are reliable methods for diagnosis based on bone densitometry, fewer than 25% of cases are currently identified. There is no consensus about which skeletal site(s) should be measured for optimal results. In this study, bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) at the radius (proximal site), lumbar spine, femoral neck, and total proximal femur regions in 537 consecutive white females age 50 and older referred by community physicians for bone densitometry. The prevalence of osteopenia and osteoporosis (based on the World Health Organization definitions) was determined, as well as the incidence of misclassification of patients based on different skeletal sites. Overall, 53.3% had osteoporosis, an additional 37.7% had osteopenia, and only 8.7% had normal BMD at all measurement sites. The prevalence was similar at all measurement sites and the incidence of misclassification was low. Given the magnitude of undetected osteoporosis and the efficacy of bone densitometry at any skeletal site, these data have important implications for the optimal deployment of bone density measurement facilities.

Journal Article↗

PubMed1997

Parathyroid hormone and related peptides for the treatment of postmenopausal osteoporosis.

Osteopenia, a skeletal condition characterised by bone loss, affects over 10% of the North American population, with a worldwide incidence of 200 m. In the absence of treatment, osteopenia usually progresses to osteoporosis, characterised by more severe bone loss and, ultimately, by fractures. In the US alone osteoporosis affects more than 25 m people, and causes more than 1.3 m fractures a year. This skeletal deterioration is accelerated subsequent to menopause and thus can affect women at a relatively young age. Treatment of postmenopausal osteoporosis primarily involves the use of hormones (calcitonin, oestrogen) or organic molecules (bisphosphonates) which are able to prevent skeletal loss through inhibition of osteoclastic bone resorption. While this may be adequate prior to significant skeletal deterioration and fractures, the patient who has already lost large amounts of bone, in the presence or absence of fractures, requires more aggressive therapy to rapidly rebuild the skeleton. There is now substantial evidence that parathyroid hormone (PTH) is an agent capable of reversing such skeletal loss characteristic of osteoporosis. Numerous animal studies, in conjunction with investigator-initiated clinical trials, have demonstrated the anabolic effects of PTH and related peptides in osteoporotic conditions associated with lack of oestrogen. Large, well-controlled clinical trials are underway to evaluate the safety and efficacy of PTH and PTH-like peptides in postmenopausal osteoporosis. The addition of these agents to the clinician's armamentarium should provide more effective treatment of this condition, thereby preventing the fractures and debilitation that frequently accompany osteoporosis.

Journal Article↗

PubMed2005

Ibandronate: a new oral bisphosphonate for postmenopausal osteoporosis.

OBJECTIVE: To review a new oral bisphosphonate, ibandronate, recently approved by the U.S. Food and Drug Administration for the treatment and prevention of postmenopausal osteoporosis. DATA SOURCE: A MEDLINE/PUBMED search was conducted to identify pertinent studies in the English language. Additional references were obtained from the bibliographies of these studies. Data over the time period of 1986 through July 2005 were reviewed. STUDY SELECTION AND DATA EXTRACTION: All studies evaluating any aspect of ibandronate in animals and humans. Studies in humans focused on the oral drug formulation. DATA SYNTHESIS: Preclinical studies established that ibandronate was an extremely potent bisphosphonate compared with its predecessors and that it was active in all animal models of human postmenopausal and corticosteroid-associated osteoporosis. Similar to other selected bisphosphonates, preclinical studies also showed that ibandronate exhibits antitumor activity and prevents and/or reduces bone metastases. As with other oral bisphosphonates, oral bioavailability is very poor (less than 1%) and substantially reduced by administration with or proximal to cations (e.g., food, antacids, mineral supplements). Clinical trials have demonstrated the efficacy and tolerability of oral ibandronate in the treatment and prevention of postmenopausal osteoporosis when administered once daily, once weekly, and even once monthly. Ibandronate also reduces the skeletal complications of bone metastases in patients with cancer, including pain, although the dosage used is much higher than that used in osteoporosis. As with other bisphosphonates, the major tolerability issue with ibandronate is upper gastrointestinal (GI) distress (dyspepsia, pain, esophagitis, esophageal and gastric ulcers). The dosage regimen for the treatment or prevention of postmenopausal osteoporosis (the only currently approved use in the United States) is 2.5 mg once a day or 150 mg once monthly (on the same date each month). Ibandronate should not be used in the presence of severe renal impairment (creatinine clearance below 30 mL/min). The usual complex administration instructions for other oral bisphosphonates apply to ibandronate as well. CONCLUSION: Oral ibandronate is an interesting addition to the therapeutic armamentarium for osteoporosis and cancer metastatic to bone. In fact, studies of ibandronate as an adjunctive treatment for cancers with a predilection to metastasize to bone are under way. Ibandronate has taken advantage of a complex pharmacodynamic profile in which its antiresorptive activity is independent of the frequency of dosing provided that a minimum dose-per-unit time is exceeded. Studies with every three-month dosing (and even less frequently) are under way. Whether or not the less frequent dosing of oral ibandronate will translate into a therapeutic advantage over older oral agents such as alendronate and risedronate is open to speculation. This is a difficult question to answer in the absence of head-to-head randomized controlled trials (RCTs). Older agents are still preferred until RCTs demonstrate that ibandronate is as safe and effective as these older agents.

Journal Article↗