Evidence-based guidelines for the pharmacological treatment of postmenopausal osteoporosis: a consensus document by the Belgian Bone Club

Abstract

Several drugs are available for the management of postmenopausal osteoporosis. This may, in daily practice, confuse the clinician. This manuscript offers an evidence-based update of previous treatment guidelines, with a critical assessment of the currently available efficacy data on all new chemical entities which were granted a marketing authorization. Osteoporosis is widely recognized as a major public health concern. The availability of new therapeutic agents makes clinical decision-making in osteoporosis more complex. Nation-specific guidelines are needed to take into consideration the specificities of each and every health care environment. The present manuscript is the result of a National Consensus, based on a systematic review and a critical appraisal of the currently available literature. It offers an evidence-based update of previous treatment guidelines, with the aim of providing clinicians with an unbiased assessment of osteoporosis treatment effect.

Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates

“…The International Osteoporosis Foundation Inadequate Responders Working Group [7] proposed pragmatic criteria suggesting inadequate response to osteoporosis treatment including occurrence of two or more fractures, or a decrease in BMD, or change in bone turnover markers inconsistent with the specific drug mechanism of action. Unfortunately, this clinical patient care database did not have bone turnover marker data for analysis in this adherent population.…”

“…In clinical trials, osteoporosis agents decrease hip fractures by up to 50%, vertebral fractures by 30-70% (depending on whether detected based on clinical symptoms or morphometry), and nonvertebral fractures by up to 30% [7,8]. When patients are adherent and persistent in their treatments, the reduction in fracture rates has been reported to be similar between clinical trials and observational cohorts [9].…”

Parenteral and oral pharmacotherapy in prevention of osteoporotic fractures in postmenopausal osteoporosis

“…Wydaje się, że potrzeba stworzenia swoistej homeostazy w obrębie tkanki kostnej poprzez wpływanie nie tylko na hamowanie resorpcji, lecz także na tworzenie nowej kości jest motorem w rozwoju badań nad nowymi lekami o działaniu anabolicznym lub anaboliczno-resorpcyjnym [1,2].…”

“…Poszczególne preparaty bisfosfonianów są porów-nywalne pod względem skuteczności przeciwzłamanio-wej, zmniejszają ryzyko wystąpienia złamań trzonów kręgowych, szyjki kości udowej oraz złamań pozakrę-gowych [1] (tab. II).…”

Transplantation of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells or Their Conditioned Medium Prevents Bone Loss in Ovariectomized Nude Mice

“…1 Most current therapies for osteoporosis, including bisphosphonates, estrogen, and selective estrogen receptor modulators, are antiresorptive agents that inhibit the boneresorbing activity of osteoclasts. 2 Although these antiresorptive therapies have been shown to increase bone mineral density (BMD) and reduce the risk of fractures, 2 long-term safety and efficacy are ongoing concerns. 3,4 Because osteoporosis results primarily from an imbalance between resorption and formation on endosteal and trabecular bone surfaces, anabolic therapy that directly stimulates bone formation by enhancing osteoblast activity is an another approach for treating osteoporosis.…”