Management of severe osteoporosis

ABSTRACT

Introduction: Severe osteoporosis represents a disease of high mortality and morbidity. Recognition of what constitutes and causes severe osteoporosis and aggressive intervention with pharmacological agents with evidence to reduce fracture risk are outlined in this review.

Areas Covered: This review is a blend of evidence obtained from literature searches from PubMed and The National Library of Medicine (USA), clinical experience and the author’s opinions. The review covers the recognition of what constitutes severe osteoporosis, and provides up-to-date references on this sub-set of high risk patients.

Expert Opinion: Severe osteoporosis can be classified by using measurements of bone densitometry, identification of prevalent fractures, and, knowledge of what additional risk factors contribute to high fracture risk. Once recognized, the potential consequences of severe osteoporosis can be mitigated by appropriate selection of pharmacological therapies and modalities to reduce the risk for falling.

KEYWORDS:

• Management of severe osteoporosis
• pharmacological therapy of severe osteoporosis
• severe osteoporosis
• treatment of high risk osteoporotic patients

Article highlights

• Osteoporosis is largely underdiagnosed and undertreated.

• The annual costs of osteoporotic fractures exceed the annual costs of caring for myocardial infarction, cerebrovascular accidents and breast cancer.

• The underdiagnoses of osteoporosis are largely due to the declining utilization of bone mineral density, the underdetection of vertebral compression fractures and the underappreciation that a low-trauma fracture in women or men after the age of 50 years is a strong risk factor for future fragility fractures in untreated people.

• Severe osteoporosis constitutes a subgroup where the fracture risk is extraordinarily high.

• There are a number of registered pharmacological choices that can be considered in severe osteoporosis.

• New therapies in development will offer an even wider variety of therapies for severe osteoporosis with new mechanisms of action.

This box summarizes key points contained in the article.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.