Treatment for osteoporosis

Current situation

  • Around 3 million people in the UK have osteoporosis. 
  • Most patients are managed in primary care.
  • Fractures caused by osteoporosis cost the NHS up to £1.8 billion annually.
  • Osteoporosis fractures account for over 50 per cent of all reported fractures (Injury 2006; 37: 691).
  • Fractures caused by osteoporosis affect one in two women and one in five men over the age of 50.

What is the evidence?

  • The FACT study showed that alendronate once weekly improved bone mineral density at a greater rate than risedronate (J Bone Miner Res 2005; 20: 141).
  • One trial showed that treatment with alendronate has greater reductions in markers of bone turnover and greater gains in bone mineral density compared with risedronate (J Clin Endocrinol Metab 2006; 91: 2,631–7).
  • One study demonstrated that risedronate provides better fracture protection in the first year of treatment compared with alendronate (Osteo- poros Int 2007; 18: 25).
  • Strontium is a dual action bone agent that decreases bone loss as well as increasing bone formation. The spinal osteoporosis therapeutic intervention trial showed a 49 per cent reduction in the incidence of new vertebral fractures in the first year (NEJM 2004; 350: 459).
  • The treatment of osteoporosis study showed that strontium reduces the risk of hip fractures by 36 per cent (J Clin Endocrinol Metab 2005; 90: 2816).
  • A study has shown that postmenopausal women taking alendronate have similar benefits when taking it for five years compared with 10 years (JAMA 2006; 296: 2,927–38).

Implications for practice

  • Compliance with treatment has been shown to be poor (Lancet 2006; 368: 973–4).
  • Patient telephone support and decreased dosing frequency improve persistence with bisphosphonates treatment (Int J Clin Pract 2006; 60: 896–905).
  • A study found that if a women had not fractured and had no risk factors, treatment for osteoporosis was effective from the age of 50 and cost-effective from the age of 60 (Bone 2005; 36: 22–32). This challenges NICE guidance.

Available guidelines

  • Royal College of Physicians’ document, Osteoporosis: Clinical Guidelines for the Prevention and Treatment.
  • In January 2005, NICE published guidance on the secondary prevention of fractures. Draft guidance on primary prevention has also been published.

Useful websites

www.nice.org.uk — NICE

www.nos.org.uk — National Osteoporosis Society

www.rcplondon.ac.uk — Royal College of Physicians guidelines

Dr Louise Newson is a GP in the West Midlands and author of ‘Hot Topics for MRCGP and General Practitioners’ PastTest 2006

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