Medical treatment of osteoporosis

Abstract

Osteoporosis is a common chronic condition that markedly increases the risk of fractures. Osteoporotic-related fractures increase morbidity and mortality and impair quality of life. Therefore, a correct approach for fracture prevention seems mandatory. Lifestyle changes should be recommended to all patients, including weight reduction if patients are obese/overweight, increasing physical activity and avoiding alcohol consumption and smoking. Additionally, calcium and vitamin D3 should be prescribed until the vitamin D deficit is resolved. Osteoporosis treatment options mainly include antiresorptives (i.e. estrogens, selective estrogen receptor modulators, bisphosphonates, denosumab) and anabolic agents (i.e. teriparatide, abaloparatide, romosozumab). Although presenting differences in efficacy and side effects, they have all been shown to increase bone mineral density (BMD) and to reduce osteoporotic-related fractures. Monotherapy with antiresorptive agents, particularly oral bisphosphonates, should be considered routinely as the first option for treatment of postmenopausal women. However, in the case of side effects, therapeutic failure or the need for long-term use, anabolic agents may be considered. In high-risk patients, anabolic agents may be considered as an initial therapeutic option. The combination of antiresorptive and anabolic agents may be useful to increase BMD compared with monotherapy, but more information is warranted to determine the effects on fracture risk.

骨质疏松症的内科治疗 摘要

骨质疏松症是一种常见的慢性疾病, 极大地增加了骨折的风险。骨质疏松相关骨折会增加发病率和死亡率, 并损害生活质量。因此, 正确的骨折预防方法似乎是强制性的。应该向所有患者推荐改变生活方式, 包括如果患者肥胖/超重, 则减轻体重, 增加体力活动, 避免饮酒和吸烟。此外, 在维生素D缺乏问题解决之前, 应服用钙和维生素D3。骨质疏松症的治疗选择主要包括骨吸收抑制剂（即雌激素、选择性雌激素受体调节剂、双膦酸盐、地诺单抗）和合成代谢药（即特立帕肽、阿巴洛肽、洛莫索珠）。尽管它们在疗效和副作用上存在差异, 但它们都被证明可以增加骨密度（BMD）, 减少骨质疏松相关的骨折。采用骨吸收抑制剂, 特别是口服双膦酸盐的单一疗法, 应该常规地被视为绝经后女性的首选治疗方案。然而, 在副作用、治疗失败或需要长期采用的情况下, 可考虑应用合成代谢剂。在高危患者中, 合成代谢药物可能被认为是一种初步的治疗选择。与单一治疗相比, 联合应用骨吸收抑制剂和合成代谢药物可能有助于增加BMD, 但需要更多的信息来确定对骨折风险的影响。

Keywords:

• Abaloparatide
• anabolic agents
• antiresorptives
• bisphosphonates
• denosumab
• fractures
• osteoporosis
• romosozumab
• selective estrogen receptor modulators
• teriparatide

Potential conflict of interest

S.P. has served as symposium speaker or advisory board member for Abbott, Amgen, Bioiberica, Candel, Ferrer, Gedeon Richter, Mylan, Pfizer, Procare, Seid, Servier, Theramex and Shionogi, and has received research grants and/or consulting fees from Amgen, Bayer, Gynea, Leon Farma, Pfizer, Preglem, Sandoz and Servier.

Additional information

Funding

Writing and editorial assistance was provided by Content Ed Net (Madrid, Spain). Editorial assistance was funded by Theramex Healthcare Spain S.L.U.