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.

 

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

'How I survived a bewildering ten-month investigation by the GMC'

'How I survived a bewildering ten-month investigation by the GMC'

How does the experience of a GMC investigation impact on the lives of doctors? One...

90% of patients would recommend their GP practice to friends or family

90% of patients would recommend their GP practice to friends or family

Nine in 10 people would recommend their GP practice to a friend or family member,...

NHS documentary spells out threat to future of the health service

NHS documentary spells out threat to future of the health service

A documentary film appearing in cinemas across the UK next month tells how the NHS...

GP funding rose much faster in rest of UK than England in 2018/19

GP funding rose much faster in rest of UK than England in 2018/19

Total NHS investment in general practice in England rose just 1.36% in real terms...

GP funding per patient rose less than 1% in 2018/19

GP funding per patient rose less than 1% in 2018/19

GP funding per patient in England rose to £154.81 in 2018/19 - up just 0.7% from...

Temporary cap extended on GP at Hand registrations in Birmingham

Temporary cap extended on GP at Hand registrations in Birmingham

A temporary cap on patients in Birmingham registering with Babylon GP at Hand has...