Medicus, Vol. 31 No. 2 Osteoporoza, 2022.
Review article
Pharmacological Treatment of Postmenopausal Osteoporosis: Guidelines vs. Daily Clinical Practice?
Mirsala Solak
Abstract
Pharmacological treatment of osteoporosis is indicated in patients with a high risk of fracture, in whom secondary causes have been excluded, and who have no contraindications for therapy. Currently we have at our disposal: four bisphosphonates (alendronate, risedronate, ibandronate and zoledronic acid), human monoclonal antibody to RANK ligand (denosumab), parathyroid hormone analogue (teriparatide), selective estrogen receptor modulators (raloxifene and bazedoxifene), and two new anabolics: a PTH-like protein analog (abaloparatide) and a humanized monoclonal antibody to sclerostin (romosozumab). Abaloparatide and romosozumab are not yet available in Croatia, and zoledronic acid is not registered for the treatment of osteoporosis, however it is used in daily clinical practice for this indication. Placebo-controlled studies have shown that with treatment the risk for vertebral fracture can be reduced by 30 - 70%, the risk for hip fracture by up to 50%, and for non-vertebral fractures by 15 - 35%. Antiresorptive treatment is recommended as initial therapy for patients with a high risk of fracture, while anabolics are recommended as initial therapy for severe osteoporosis and a very high risk of fracture. Hormonal therapy (estrogen and estrogen/progestin combination) can be used in women with postmenopausal osteoporosis who have persistent menopausal symptoms and can’t tolerate other available treatment for osteoporosis, taking into account potential contraindications and risks. When choosing the optimal tretament we have to consider the individual risk for fracture in each patient, as well as the effectiveness, price, route of administration and potential side effects of pharmacotherapy.
Keywords
osteoporosis; pharmacotherapy; treatment; antiresorptive treatment; anabolics
Hrčak ID:
291564
URI
Publication date:
17.1.2023.
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