Osteoporosis, treatment

Calcitonin is indicated for osteoporosis treatment for women at least 5 years past menopause. Although limited data suggest beneficial effects in men and concomitantly with glucocorticoids, these indications are not FDA approved. 

Goldstein SR, Nanavati N (2002) Adverse events that are associated with the selective estrogen receptor modulator levormeloxifene in an aborted phase III osteoporosis treatment study. Am J Obstet Gynecol 187 521-527... 

Rossini, M., Bianchi, G., Di Munno, O., Giannini, S., Mmisola, S., Sinigaglia, L., and Adami, S. (2006). Determinants of adherence to osteoporosis treatment in clinical practice. Osteo-poros. Int. 17, 914-921. 

Treatment ot increase bone mass in men with osteoporosis Treatment of glucocorticoid induced osteoporosis... 

In postmenopausal osteoporosis treatment with calcitriol plus etidronate or calcitonin produced improvement in spinal bone mineral density, but a high rate of nephrotoxic adverse events (17). 

Maricic M. Glucocorticoid-induced osteoporosis treatment options and guidelines. Curr Osteoporos Rep. 2005 3 25-29. 

Clinical Knowledge Summaries (2006) Osteoporosis-treatment-management (May 2006). Available atwww.cks.library.nhs.uk/osteoporosis treatment [Accessed 4 July 2008],... 

Clinical Knowledge Summaries. Osteoporosis (2006). Available at http //cks.library. nhs.uk/osteoporosis treatment [Accessed 8 October 2008]. 

Reid DM, Hughes RA, Laan RF, Sacco-Gibson NA, Wenderoth DH, Adami S, Eusebio RA, Devogelaer JP. Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women a randomized trial. European Corticosteroid-Induced Osteoporosis Treatment Study. J Bone Miner Res 2000 15(6) 1006-13. 

Treatment of osteoporosis depends on the cause. In secondary osteoporosis, treatment is directed at the underlying condition. Most therapies for the treatment of postmenopausal osteoporosis are directed at decreasing osteoclastic bone resorption. Antiresorptive therapies include bisphosphoiiates (alendronate and risedronate), estrogen replacement, selective estrogen receptor modulators (raloxifene), and calcitonin (nasal spray or injection). The FDA has recently approved recombinant hPTH(l-34) (injection), the first approved therapy for stimulating bone formation. 

Osteoporosis prevention remains an indicated use of estrogen products however, nonestrogen products, such as raloxifene and bis-phosphonates, are as effective as hormone therapy for preventing osteoporosis (Table 80-7). The FDA has withdrawn the osteoporosis treatment indication from estrogen products. 

Bisphosphonates are the cornerstone for osteoporosis treatment. They are the drugs of choice because they prevent both nonvertebral (especially hip) and vertebral fractures. 

Doxercalciferol (la-hydroxyvitamin D2) is under investigation for osteoporosis treatment. 

Some patients cannot tolerate oral bisphosphonates. Zoledronic acid is not FDA-approved for osteoporosis treatment, but is sometimes administered intravenously once yearly in patients for whom bisphosphonates are indicated. It improved BMD similarly to oral bisphosphonates, but the impact on fracture rates is under investigation. Quarterly administration of intravenous pamidronate or ihandronate also improves BMD. 

Calcitonin is released from the thyroid gland when serum calcium is elevated. Salmon calcitonin is used clinically because it is more potent and longer lasting than the mammalian form. Pharmacologic doses decrease bone resorption. Calcitonin is indicated for osteoporosis treatment for women at least 5 years past menopause. Although the agent is also used in men, it is not approved for this indication. Because calcitonin reduces fracture risk to a lesser extent than other osteoporosis medications, calcitonin is reserved for second-line treatment. 

Teriparatide contains the first 34 amino acids in human parathyroid hormone and represents a novel approach to osteoporosis treatment. Although hyperparathyroidism leads to bone loss (see Fig. 88-3), therapeutic doses (for shorter periods of time) conversely improve BMD and rednce fractnre risk. Parathyroid hormone is currently the only approved osteoporosis medication that works by stimulating bone formation. Becanse of adverse effects and cost concerns, teriparatide is reserved for treating those at high risk of osteoporosis-related fracture who cannot or will not take or have failed bisphosphonate therapy. 

Crandall C Gender differences in osteoporosis treatment A review of clinical research. J Gend Specif... 

Osteoporosis Treatment Marine Algal Compounds Jayachandran Venkatesan and Se-Kwon ... 

The goals of osteoporosis treatment are to control pain from the disease, reduce bone loss, and prevent bone fractures with medicines or hormone therapies. There are several types of treatments for osteoporosis including most famous bisphosphonates, estrogen agonists/antagonists, parathyroid... 

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