From International Journal of Clinical Rheumatology
08/02/2011; Int. J. Clin. Rheumatol.. 2011;6(3):325-332. © 2011
Abstract
Osteoporosis is a very common disease that affects both men and women and produces an important burden. Fracture prevention is the primary treatment goal for patients with osteoporosis. There are several treatments available nowadays with anabolic, antiresorptive or dual actions. A great number of new drugs are under study. In this brief review, we highlight the knowledge regarding them so far.Introduction
The concept of osteoporosis was introduced in 1990 as "a skeletal disorder characterized by low bone mass and compromised bone strength, resulting in increased bone fragility and susceptibility to fracture".This definition comments on the intimate association between fractures and bone strength and provides a useful framework for reviewing recent developments and advances involving the diagnosis and management of individuals with compromised bone strength.Osteoporosis is a very common disease that can occur in populations of all types and ages, having significant physical, psychosocial and financial consequences.Fracture prevention is the primary treatment goal for patients with osteoporosis.
Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or consequences of falls.
In this article we briefly review some promising new treatments for osteoporosis.
New Assessment Tools for Fracture Risks & Treatment Decisions
New tools have been developed in order to facilitate both the diagnosis and management of bone metabolic diseases. They are useful to estimate the long-term risk of suffering a fracture and sometimes would advise to indicate a treatment or even sometimes to discontinue them. These tools are FRAX®, Study of Osteoporosis Fractures (SOF) and QFracture™.FRAX & SOF
The WHO developed a computer-generated algorithm, FRAX, which will supply clinicians with a tool to estimate absolute, time-specific fracture risk quantitatively.[4–6] This useful tool provides country- and ethnic-specific 10-year hip and major osteoporotic fracture (hip, distal forearm, shoulder, vertebral body) risks, based on information entered into the calculator, which is available for free online.[101] The information requested can be easily obtained from simple questioning; it includes age, sex, weight, height, personal and family history of fracture, current tobacco and alcohol consumption, corticosteroid usage, previous conditions associated with secondary osteoporosis, and history of rheumatoid arthritis. In the USA, bone density values at the hip are also included in the data. Threshold values for the instauration of bone-strengthening medication are established for those individuals who have a 3% or more risk of a hip fracture and/or 20% risk or more of a major osteoporotic fracture. The FRAX calculator is particularly useful for younger, healthy, postmenopausal females with osteopenia, a group of people with a relatively low 10-year fracture risk.The American SOF Research Group has also created another assessment tool for fracture risk. The SOF model, unlike FRAX, is based only on BMD and age. However, it predicts the 10-year risk of hip and major osteoporotic fracture as well as the FRAX tool in a group of postmenopausal females, 65 years and old.[7,8] These findings highlight the importance of age as a risk factor for fragility fractures.
Both the FRAX and SOF models have demonstrated that older people with low bone density and a history of fragility fracture are at highest risk for sustaining further fragility fractures.
QFracture
A third tool, named QFracture, was also published recently. It has some similarities to FRAX, and estimates 10-year risks of fracture (major osteoporotic fracture and hip fracture) from a number of risk factors,[9] accessible free at.[102] It has the advantage of not requiring densitometry. For a given patient, the estimated risks obtained with both tools can sometimes be similar but sometimes not. The differences between FRAX and QFracture can be seen in Box 1. The exact value of QFracture in the management of osteoporosis and the advantages or disadvantages compared with FRAX need to be studied.The greater concerns regarding the potential adverse effects and costs of long-term use of antiresorptive agents is likely to be increasing the interest in identifying and treating those individuals who have a significantly increased absolute fracture risk. Fracture assessment tools provide critical quantitative information on fracture risk and may aid in this endeavor.
Future Perspective
Treatment of osteoporosis has changed substantially in recent years. Only 15 years ago, we had calcitonin, estrogen, etidronate and alendronate. Today, the therapeutic arsenal is huge and varied and we have a deeper understanding of the side effects that occur as a consequence of prolonged use of some drugs such as bisphosphonates.New drugs are emerging for the treatment of osteoporosis, characterized by acting on very specific bone cell physiology, and sometimes it is almost a true therapy with monoclonal antibodies that regulates bone cell pathophysiology. Perhaps the most important aspect that remains is to check there are no major side effects in the long term.
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