Evidence base: Osteoporosis

A summary of the evidence behind the diagnosis and management of osteoporosis

Osteoporosis: bisphosphonates work by reducing bone loss (Photograph: Professor P Motta)
Osteoporosis: bisphosphonates work by reducing bone loss (Photograph: Professor P Motta)

Clinical trials
Alendronic acid was the first bisphosphonate that was to be proven effective in fracture intervention.

  • Black DM, Cummings SR, Karpf DB et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996; 348: 1535-41.

Similar trials demonstrated effectiveness of risedronate and strontium ranelate. Ibandronate was shown to be equally effective to alendronic acid.

The HORIZON Pivotal Fracture Trial demonstrated effectiveness of once-yearly IV zoledronic acid.

The most recent medication proven to be effective is denosumab, a six-monthly subcutaneous injection.

Other notable trials were those of the Women's Health Initiative (WHI). These studies proved the effectiveness of HRT in reducing fractures but also demonstrated that HRT carried significant extraskeletal risks.

  • Rossouw JE, Anderson GL, Prentice RL et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288: 321-33.

Guidelines
NICE guidance is available for the use of medications in post-menopausal women. Guidelines from NICE relating to the treatment of both women and men are in development.

More online

Contributed by Dr Mark Cooper, senior clinical lecturer in endocrinology at the University of Birmingham and Queen Elizabeth Hospital Birmingham.

 

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