Osteoporosis evaluation

Compared with postmenopausal osteoporosis, few clinical trials have been conducted evaluating therapies in men. Although alendronate and calcitonin have both been studied, only alendronate reduces fracture rates in men. Teriparatide also has been studied, but no data are available yet on fracture rates. At this time, alendronate and teriparatide are approved by the FDA for the treatment of osteoporosis in men. Owing to proven benefit in reducing fractures and relative safety, alendronate should be considered first-line treatment for primary osteoporosis in men. Teriparatide should be reserved as alternate therapy in this population. 

Evaluate patients for progression of osteoporosis, including signs and symptoms of new fragility fracture (e.g., localized pain), loss of height, and physical deformity (e.g., kyphosis). Patients should be assessed on an annual basis or more often if new symptoms present. 

Osteoporosis associated with RA follows a multifaceted pathogenesis, but the primary mechanism likely is mediated by osteoclast activity.12 The cytokines involved in the inflammatory process directly stimulate osteoclast and inhibit osteoblast activity. Additionally, arthritis medications can lead to increased bone loss. Bone mineral density should be evaluated at baseline and routinely using dual-energy x-ray absorptiometry.11,12... 

Research in humans has been mainly focused either in the prevention of osteoporosis in healthy postmenopausal women or in the treatment of already osteoporotic women. Some research programs have extensively used estimates of biochemical markers of bone remodeling, while others have mostly relied on evaluations of BMD, histomorphometry, and fracture incidence. 

Badia X, Diez-Perez A, Lahoz R, Lizan L, Nogues X, Iborra J (2004) The ECOS-16 questionnaire for the evaluation of health related quality of life in post-menopausal women with osteoporosis. Health Qual Life Outcomes 2(1) 41... 

Delmas PD, Ensrud KE, Adachi JD, Harper KD, Sarkar S, Gennari C, Reginster JY, Pols HAP, Recker RR, Harris ST, Wu W, Genant HK, Black DM, Eastell R for the Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87 3609-3617... 

Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. J Am Med Assoc 282 637-645... 

Kanis JA, Johnell O, Black DM, Downs RW Jr, Sarkar S, Fuerst T, et al. (2003) Effect of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis a reanalysis of the Multiple Outcomes of Raloxifene Evaluation trial. Bone 33 293-300... 

Additionally it has been observed that raloxifene reduces the risk of breast cancer by 58-66%, without producing an increased risk of endometrial cancer in postmenopausal women (Cummings et al. 1999 Jordan et al. 1998). The Multiple Outcomes of Raloxifene Evaluation (MORE) clinical trial is particularly eloquent in this regard (Cummings et al. 1999). A total of7704 postmenopausal women (average age 66.5 years) with osteoporosis and without history of breast or endometrial cancer were included. The trial, which was randomized and double-blind, used two doses of raloxifene (60 or 120mg/d) or placebo to as-... 

Weaver, C. M., and Liebman, M. (2002). Biomarkers of bone health appropriate for evaluating functional foods designed to reduce risk of osteoporosis. Br. J. Nutr. 88, S225-S232. 

A 48-year-old white man is noted to have osteopenia on a routine LS spine film while being evaluated for back pain. His bone density reveals osteoporosis of both his hip and LS spine. All of the choices are possible EXCEPT... 

HCT-1026 (nitwflurbipwfen) is a nitric oxide-donating derivative of the NSAID flurbiprofen. It is undergoing Phase 1 clinical evaluation for the treatment of Alzheimer disease, but it is more advanced (Phase 11) for overactive bladder and osteoporosis. 

Li, Chines and Meredith (2004) quote three clinical trials evaluating the effectiveness of alendronate, risedronate and raloxifene in increasing BMD and reducing fracture risk in osteoporosis. These treatments are seen to reduce fracture risk by similar amounts 47 per cent, 49 per cent and 46 per cent respectively, yet their effects on increasing BMD are somewhat different 6.2 per cent, 5.8 per cent and 2.7 per cent respectively. Drawing conclusions on the relative effectiveness of these treatments based solely in terms of the surrogate BMD would clearly be misleading. 

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