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

Abstract

Abstract:Background: Adherence to oral bisphosphonates is often low, but even adherent patients may remain at elevated fracture risk. The goal of this study was to estimate the proportion of bisphosphonate-adherent women remaining at high risk of fracture.

Demineralization–remineralization dynamics in teeth and bone

“…Some drugs have been developed to either reduce bone resorption (eg, bisphosphonates 198 ) or promote bone formation (hormonal replacement, 199 calcium, and vitamin D supplements). Combination and sequential treatment using both bone formation stimulator and bone resorption inhibitors have been attempted.…”

“…199 Generally, serious side effects, however, have now been associated with the extensive use of these drugs. 198,200,201 This, however, is not the main focus of this review. Only the materials with remineralizing action will be covered in details.…”

Inclusive Terminology for Aging

“…We suggested that compliance or oral bisphosphonate bioavailability deteriorates with time, leading to greater bone turnover, potentially resulting in greater fracture risk, as Drieling and colleagues demonstrated. 1 Although the current paradigm, as well as Drieling and colleagues, 1 suggests putting people on prolonged bisphosphonate treatment on a drug holiday to reduce oversuppression of bone turnover, 3 our results, as well as other observations indicating a greater incidence of fractures early after initiation of a drug holiday, [4][5][6] suggest that a drug holiday could be risky for many people and that re-evaluation of individuals on a prolonged course of oral bisphosphonates should probably include, in addition to clinical and densitometric evaluation, an assessment of bone turnover, to exclude what could be classified as subclinical treatment failure. Individuals with high bone turnover could thus be considered for a parenteral antiresorptive drug.…”

Consequences of Long‐Term Oral Bisphosphonate Treatment

“…We suggested that compliance or oral bisphosphonate bioavailability deteriorates with time, leading to greater bone turnover, potentially resulting in greater fracture risk, as Drieling and colleagues demonstrated. 1 Although the current paradigm, as well as Drieling and colleagues, 1 suggests putting people on prolonged bisphosphonate treatment on a drug holiday to reduce oversuppression of bone turnover, 3 our results, as well as other observations indicating a greater incidence of fractures early after initiation of a drug holiday, [4][5][6] suggest that a drug holiday could be risky for many people and that re-evaluation of individuals on a prolonged course of oral bisphosphonates should probably include, in addition to clinical and densitometric evaluation, an assessment of bone turnover, to exclude what could be classified as subclinical treatment failure. Individuals with high bone turnover could thus be considered for a parenteral antiresorptive drug.…”