Guidelines for Osteoporosis Treatment
Drug Treatment Plan Should Consider Risks and Benefits of Individual Patients
Sept. 15, 2008 -- Drugs are helpful in treating
osteoporosis, but figuring out which drug to prescribe means evaluating the
pluses and minuses of each option for each patient, according to new
recommendations from The American College of Physicians.
As people get older their bones become less dense and more vulnerable to
fracture. In its severe form, this condition is known as osteoporosis.
Osteoporosis is particularly common in women after menopause, though men get it
The American College of Physicians makes these news recommendations:
- Doctors should offer drugs to people who have known osteoporosis and people
who have experienced what's called a fragility fracture -- when a bone breaks
without significant trauma.
- Doctors should consider preventive treatment for patients at risk of
getting osteoporosis, the guidelines say.
- Doctors should take into account a patient's individual risk and benefits
when selecting among drug treatment options for osteoporosis
- Additional research should be done to investigate osteoporosis treatment in
men and women.
The authors collectively reviewed data from several different drug studies
to come up with their evidence-based guidelines.
Among the findings:
- Bisphosphonates are used for prevention or treatment of osteoporosis. They
reduce fractures, but there isn't good information on how long
people should take these drugs. Adverse effects include acid reflux, and
problems of the esophagus; a rare but serious side effect involves the
breakdown of the jaw bone.
- Estrogens reduce the incidence of fractures but can increase risk for some
kinds of cancer, stroke, and blood clots.
- A non-estrogen drug that focuses on estrogen receptors (also known as a
SERM, or selective estrogen receptor modulator) prevents spinal fractures but
doesn't reduce the likelihood of a hip fracture. Adverse effects include blood
- Calcitonin is used for treatment. The authors note fair-quality evidence
that it reduces incidence of spine fractures, though evidence suggests
calcitonin does not reduce other kinds of fractures. No clinically significant
side effects are noted in the guideline.
- Teriparatide is used for osteoporosis treatment. It prevents spine
fractures, but evidence for other types of fractures are mixed. No clinically
significant side effects are noted in the guideline.
- Vitamin D and calcium supplements, taken together, have a modest effect on
fractures. It is unclear how effective either is if taken alone.