, Volume 20, Issue 3 Supplement, pp 255-256
Date: 09 May 2009

Pharmacologic treatment to prevent fractures: from markers to patients

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Pierre Delmas made fundamental contributions to our understanding of the mechanisms of action of treatments for osteoporosis, played an important role in the design and publication of most of the agents in our armamentarium of treatments for osteoporosis, and provided evidence and guidance about the use of markers of bone turnover in clinical practice.

The “BMD paradigm” that improvements in bone mineral density (BMD) directly translate into decreases in fracture risk was so strong that the FDA approved estrogen for prevention and treatment of osteoporosis based on trials showing that it significantly improved BMD. Two randomized trials undermined this paradigm. The first showed that sodium fluoride improved spine BMD by 10% but did not decrease the risk of fractures – indeed, it seemed to increase the risk of stress fractures. This forced a realization that histologically abnormal bone, as induced by fluoride, may improve BMD but not bone strength.

The second assault on the BMD paradigm