Abstract
The objectives of the treatment of osteoporosis are to decrease the morbidity associated with the disease. An important aspect of treatment is to manipulate bone loss of the untreated disorded disorder to decrease the risk of future fracture.
Many of the interventions that are used in osteoporosis decrease the rate of bone remodelling, and this is the mechanism whereby they decrease the rate of bone loss. Such interventions include pharmacological doses of calcium, the calcitonins and the bisphophonates. The gonadal steroids have added effects in that, not only do they decrease bone remodelling, but they also correct the imbalance at each remodelling site. This means that bone loss is prevented. The ability of these agents to prevent or decrease bone loss makes them ideal candidates for the prevention of osteoporosis but, as currently formulated, cannot restore skeletal mass once this has been lost in established osteoporosis.
There are a number of other interventions and cyclical regimes which appear to have greater anabolic effects on the skeleton. Of these, the greatest interest has been shown in fluoride which has marked effects on trabecular bone mass by altering the balance between the amount resorbed and formed at each remodelling site. A major problem in the application of anabolic regimes is that several forms of osteoporosis, including postmenopausal osteoporosis, are associated with loss of trabecular elements in spongy bone. This decreases the strength of bone out of proportion to the amount of bone lost. Anabolic regimens such as fluoride increase trabecular width but do not restore skeletal connectivity, so that despite the restoration of skeletal mass, strength is not proportionaly increased.
The ultimate indicator of osteoporosis treatments is their effect on fracture frequency. A great deal of evidence indicates that early intervention, i.e. shortly after menopause or in later life, is associated with the maintenance of bone mass and a decrease in the future frequency.
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Kanis, J.A., Aaron, J., Benéton, M. et al. Treatment of osteoporosis. J Bone Miner Metab 11, S17–S24 (1993). https://doi.org/10.1007/BF02383839
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DOI: https://doi.org/10.1007/BF02383839