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Individualizing osteoporosis therapy

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Abstract

Guidelines for osteoporosis treatment are available; however, these guidelines suggest when to treat patients, without specific recommendations on what drugs to prescribe in various situations. Choice of osteoporosis therapy should be individualized based on consideration of the efficacy, safety, cost, convenience (i.e., dosing regimen and delivery), and other non-osteoporosis-related benefits associated with each agent. Bisphosphonates, administered orally or intravenously, should be considered first-line therapy, particularly in older patients, owing to their efficacy across multiple skeletal sites; however, there are potential short- and long-term safety concerns. Selective estrogen receptor modulators should be considered for younger postmenopausal women at greater risk for vertebral than hip fractures or as second-line therapy in women who cannot tolerate first-line therapies. Low-dose hormone therapy may be appropriate as prevention in women with menopausal symptoms at lower fracture risk. Calcitonin, with its relatively benign safety profile, may be appropriate for elderly women who may have difficulty following the complex dosing schedules of oral bisphosphonates. Anabolic therapies such as teriparatide should be considered for high-risk patients. Strontium ranelate (approved outside of North America), with both anabolic and antiresorptive properties, may be appropriate for women who cannot tolerate or are unable to take bisphosphonates. Denosumab is a monoclonal antibody appropriate for women at high fracture risk or who have failed other osteoporosis therapies, and may be considered in patients with renal insufficiency. It will be important to incorporate newer agents (e.g., bazedoxifene, tissue selective estrogen complex) into this individualized treatment paradigm to optimize clinical outcomes in patients with osteoporosis.

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Acknowledgments

Medical writing support for this manuscript was provided by Bo Choi, PhD, of MedErgy and was funded by Pfizer Inc. The authors were not compensated and retained full editorial control over the content of the article.

Conflicts of interest

Dr. Silverman has received research grants from Pfizer, Eli Lilly, Amgen, and Novartis; he has served as a consultant and on the speakers bureau for Pfizer, Eli Lilly, Amgen, Novartis, and Warner Chilcott. Dr. Christiansen is the chairman of Nordic Bioscience A/S and CCBR/Synarc; he has also served as a consultant for Roche, Wyeth-Ayerst, Eli Lilly, Novartis, Novo Nordisk, Proctor and Gamble, Groupe Fournier, Besins EscoVesco, MSD, Chiesi, Boehringer Mannheim, and Pfizer.

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Authors and Affiliations

  1. Cedars-Sinai Medical Center and University of California, Los Angeles, CA, USA

    S. Silverman

  2. Center for Clinical and Basic Research, Ballerup, Denmark

    C. Christiansen

  3. 8641 Wilshire Blvd., Suite 301, Beverly Hills, CA, 90211, USA

    S. Silverman

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  1. S. Silverman
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  2. C. Christiansen
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Correspondence to S. Silverman.

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Silverman, S., Christiansen, C. Individualizing osteoporosis therapy. Osteoporos Int 23, 797–809 (2012). https://doi.org/10.1007/s00198-011-1775-y

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