Medical treatment of vertebral osteoporosis

  • K. Lippuner
Conference paper


Although osteoporosis is a systemic disease, vertebral fractures due to spinal bone loss are a frequent, sometimes early and often neglected complication of the disease, generally associated with considerable disability and pain. As osteoporotic vertebral fractures are an important predictor of future fracture risk, including at the hip, medical management is targeted at reducing fracture risk. A literature search for randomized, double-blind, prospective, controlled clinical studies addressing medical treatment possibilities of vertebral fractures in postmenopausal Caucasian women was performed on the leading medical databases. For each publication, the number of patients with at least one new vertebral fracture and the number of randomized patients by treatment arm was retrieved. The relative risk (RR) and the number needed to treat (NNT, i.e. the number of patients to be treated to avoid one radiological vertebral fracture over the duration of the study), together with the respective 95% confidence intervals (95%CI) were calculated for each study. Treatment of steroid-induced osteoporosis and treatment of osteoporosis in men were reviewed separately, based on the low number of publications available. Forty-five publications matched with the search criteria, allowing for analysis of 15 different substances tested regarding their anti-fracture efficacy at the vertebral level. Bisphosphonates, mainly alendronate and risedronate, were reported to have consistently reduced the risk of a vertebral fracture over up to 50 months of treatment in four (alendronate) and two (risedronate) publications. Raloxifene reduced vertebral fracture risk in one study over 36 months, which was confirmed by 48 months’ follow- up data. Parathormone (PTH) showed a drastic reduction in vertebral fracture risk in early studies, while calcitonin may also be a treatment option to reduce fracture risk. For other substances published data are conflicting (calcitriol, fluoride) or insufficient to conclude about efficacy (calcium, clodronate, etidronate, hormone replacement therapy, pamidronate, strontium, tiludronate, vitamin D). The low NNTs for the leading substances (ranges: 15–64 for alendronate, 8–26 for risedronate, 23 for calcitonin and 28–31 for raloxifene) confirm that effective and efficient drug interventions for treatment and prevention of osteoporotic vertebral fractures are available. Bisphosphonates have demonstrated similar efficacy in treatment and prevention of steroid-induced and male osteoporosis as in postmenopausal osteoporosis. The selection of the appropriate drug for treatment of vertebral osteoporosis from among a bisphosphonate (alendronate or risedronate), PTH, calcitonin or raloxifene will mainly depend on the efficacy, tolerability and safety profile, together with the patient’s willingness to comply with a long-term treatment. Although reduction of vertebral fracture risk is an important criterion for decision making, drugs with proven additional fracture risk reduction at all clinically relevant sites (especially at the hip) should be the preferred options.


Review Medical treatment Vertebral fractures Osteoporosis Relative risk reduction Number needed to treat 


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  1. 1.
    Adachi JD, Bensen WG, Brown J, et al (1997) Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med 337:382–387CrossRefPubMedGoogle Scholar
  2. 2.
    Adachi JD, Saag KG, Delmas PD, et al (2001) Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids. Arthritis Rheum 44:202–211CrossRefPubMedGoogle Scholar
  3. 3.
    Adinoff AD, Hollister JR (1983) Steroid-induced fractures and bone loss in patients with asthma. New Engl J Med 309:265–268PubMedGoogle Scholar
  4. 4.
    Adler RA, Rosen CJ (1994) Glucocorticoids and osteoporosis. Endocrinol Metab Clin North Am 23:641–654PubMedGoogle Scholar
  5. 5.
    Alexandersen P, Riis BJ, Christiansen C (1999) Monofluorophosphate combined with hormone replacement therapy induces a synergistic effect on bone mass by dissociating bone formation and resorption in postmenopausal women: a randomized study. J Clin Endocrinol Metab 84:3013–3020CrossRefPubMedGoogle Scholar
  6. 6.
    Alexandersen P, Toussaint A, Christiansen C, Devogelaer P, et al (2001) Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA 285:1482–1488CrossRefPubMedGoogle Scholar
  7. 7.
    Aloia JF, Vaswani A, Yeh JK, Ellis K, et al (1988) Calcitriol in the treatment of postmenopausal osteoporosis. Am J Med 84:401–408CrossRefPubMedGoogle Scholar
  8. 8.
    Amin S, Lavalley M, Simms RW, Felson DT (2002) The comparative efficacy of drug therapies used for the management of corticosteroid-induced osteoporosis: a meta-regression. J Bone Miner Res 17:1512–1526PubMedGoogle Scholar
  9. 9.
    Black DM, Palermo L, Nevitt MC, et al (1995) Comparison of methods for defining prevalent vertebral deformities: the study of osteoporotic fractures. J Bone Miner Res 10:890–902Google Scholar
  10. 10.
    Black DM, Cummings SR, Karpf DB, Cauley JA, et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541PubMedGoogle Scholar
  11. 11.
    Black DM, Thompson D, Bauer DC, Ensrud K, et al (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metab 85:4118–4124CrossRefPubMedGoogle Scholar
  12. 12.
    Blau LA, Hoehns JD (2003) Analgesic efficacy of calcitonin for vertebral fracture pain. Ann Pharmacother 37:564–570CrossRefPubMedGoogle Scholar
  13. 13.
    Bombardier C, Laine L, Reicin A, et al — VIGOR Study Group (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med 343:1520–1528CrossRefPubMedGoogle Scholar
  14. 14.
    Bone HG (2001) Development and evaluation of new drugs for osteoporosis. Osteoporosis (Second Edition) 2:533–538Google Scholar
  15. 15.
    Bone HG, Downs RW, Tucci JR Harris ST, et al (1997) Dose-response relationships for alendronate treatment in osteoporotic elderly women. J Clin Endocrinol Metab 82:265–274CrossRefPubMedGoogle Scholar
  16. 16.
    Brumsen C, Papapoulos SE, Lips P, Geelhoed-Duijvestijn P, et al (2002) Daily oral pamidronate in women and men with osteoporosis: a 3-year randomized placebo-controlled clinical trial with a 2-year open extension. J Bone Miner Res 17:1057–1064PubMedGoogle Scholar
  17. 17.
    Burger H, Van Daele PL, Algra D, et al (1994) Vertebral deformities as predictors of non-vertebral fractures. BMJ 309:991–992PubMedGoogle Scholar
  18. 18.
    Canalis E (2003) Mechanisms of glucocorticoid-induced osteoporosis. Curr Opin Rheumatol 15:454–457CrossRefPubMedGoogle Scholar
  19. 19.
    Cauley JA, Black DM, Barrett-Connor E, Harris F, et al (2001) Effects of hormone replacement therapy on clinical fractures and height loss: the Heart and Estrogen/Progestin Replacement Study (HERS). Am J Med 110:442–450CrossRefPubMedGoogle Scholar
  20. 20.
    Chesnut CH, Silverman S, Andriano K, Genant H, et al (2000) A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence Of Osteoporotic Fractures study. Am J Med 109:267–276PubMedGoogle Scholar
  21. 21.
    Chevalley T, Rizzoli R, Nydegger V, Slosman D, et al (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 4:245–252PubMedGoogle Scholar
  22. 22.
    Clemmesen B, Ravn P, Zegels B, Taquet AN, et al (1997) A 2-year phase II study with 1-year of follow-up of risedronate (NE-58095) in postmenopausal osteoporosis. Osteoporos Int 7:488–495Google Scholar
  23. 23.
    Cohen S, Levy RM, Keller M, Boling E, et al (1999) Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309–2318CrossRefPubMedGoogle Scholar
  24. 24.
    Consensus Development Conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650Google Scholar
  25. 25.
    Cranney A, Welch V, Adachi JD, Homik J, et al (2000) Calcitonin for the treatment and prevention of corticosteroid-induced osteoporosis. Cochrane Database Syst Rev 2:1983Google Scholar
  26. 26.
    Cummings SR, Nevitt MC, Browning WR, et al (1995) Risk factors for hip fracture in white women. N Engl J Med 322:767–773CrossRefGoogle Scholar
  27. 27.
    Cummings SR, Black DM, Thompson DE, Applegate WB, et al (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082CrossRefPubMedGoogle Scholar
  28. 28.
    Delmas PD, Ensrud KE, Adachi JD, Harper KD, et al (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87:3609–3617CrossRefPubMedGoogle Scholar
  29. 29.
    Dursun N, Dursun E, Yalcin S (2001) Comparison of alendronate, calcitonin and calcium treatments in postmenopausal osteoporosis. Int J Clin Pract 55:505–509PubMedGoogle Scholar
  30. 30.
    Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645PubMedGoogle Scholar
  31. 31.
    Falch JA, Odegaard OR, Finnanger AM, Matheson I (1987) Postmenopausal osteoporosis: no effect of three years treatment with 1, 25-dihydroxycholecalciferol. Acta Med Scand 221:199–204PubMedGoogle Scholar
  32. 32.
    Fogelman I, Ribot C, Smith R, Ethgen D, et al (2000) Risedronate reverses bone loss in postmenopausal women with low bone mass: results from a multinational, double-blind, placebocontrolled trial. J Clin Endocrinol Metab 85:1895–1900CrossRefPubMedGoogle Scholar
  33. 33.
    Gallagher JC, Goldgar D (1990) Treatment of postmenopausal osteoporosis with high doses of synthetic calcitriol. A randomized controlled study. Ann Intern Med 113:649–655PubMedGoogle Scholar
  34. 34.
    Gallagher JC, Riggs BL, Recker RR, Goldgar D (1989) The effect of calcitriol on patients with postmenopausal osteoporosis with special reference to fracture frequency. Proc Soc Exp Biol Med 191:287–292PubMedGoogle Scholar
  35. 35.
    Greenspan S, Myers E, Maitland L, et aI (1994) Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 271:128–133CrossRefPubMedGoogle Scholar
  36. 36.
    Gutteridge DH, Stewart GO, Prince RL, Price RI et al. (2002) A randomized trial of sodium fluoride (60 mg) ± estrogen in postmenopausal osteoporotic vertebral fractures: increased vertebral fractures and peripheral bone loss with sodium fluoride; concurrent estrogen prevents peripheral loss, but not vertebral fractures. Osteoporos Int 13:158–170CrossRefPubMedGoogle Scholar
  37. 37.
    Harris ST, Watts NB, Jackson RD, Genant HK, et al (1993) Four-year study of intermittent cyclic etidronate treatment of postmenopausal osteoporosis: three years of blinded therapy followed by one year of open therapy. Am J Med 95:557–567CrossRefPubMedGoogle Scholar
  38. 38.
    Harris ST, Watts NB, Genant HK, McKeever CD, et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282:1344–1352CrossRefPubMedGoogle Scholar
  39. 39.
    Häuselmann HJ, Rizzoli R (2003) A comprehensive review of treatments for postmenopausal osteoporosis. Osteoporos Int 14:2–12CrossRefPubMedGoogle Scholar
  40. 40.
    Heikki Frick M, Elo O, Haapa A, et al (1987) Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors and incidence of coronary heart disease. New Engl J Med 317:1237–1245PubMedGoogle Scholar
  41. 41.
    Hizmetli S, Elden H, Kaptanoglu E, Nacitarhan V, et al (1998) The effect of different doses of calcitonin on bone mineral density and fracture risk in postmenopausal osteoporosis. Int J Clin Pract 52:453–455PubMedGoogle Scholar
  42. 42.
    Hulley S, Grady D, Bush T, Furberg C, et al (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 280:605–613CrossRefPubMedGoogle Scholar
  43. 43.
    Hulley S, Furberg C, Barrett-Connor E, Cauley J, et al (2002) Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 288:58–66CrossRefPubMedGoogle Scholar
  44. 44.
    Jalava T, Sarna S, Pylkkanen L, et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260PubMedGoogle Scholar
  45. 45.
    Kanis JA, Brazier JE, Stevenson M (2002) Treatment of established osteoporosis: a systematic review and costutility analysis. Health Technology Assessment 6(29)Google Scholar
  46. 46.
    Kleerekoper M, Peterson EL, Nelson DA, Phillips E, et al (1991) A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis. Osteoporos Int 1:155–161CrossRefPubMedGoogle Scholar
  47. 47.
    Lafague-Proust MH, Boudignon B, Thierry T (2003) Glucocorticoid-induced osteoporosis: pathophysiological data and recent treatments. Joint Bone Spine 70:109–118CrossRefPubMedGoogle Scholar
  48. 48.
    Lane NE, Sanchez S, Modin GW, Genant HK, Pierini E, Arnaud CD (1998) Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. J Clin Invest 102:1627–1633PubMedGoogle Scholar
  49. 49.
    Levis S, Quandt SA, Thompson D, Scott J, et al (2002) Alendronate reduces the risk of multiple symptomatic fractures: results from the fracture intervention trial. J Am Geriatr Soc 50:409–415CrossRefPubMedGoogle Scholar
  50. 50.
    Liberman UA, Weiss SR, Brö J, Minne HW, et al (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 333:1437–1443CrossRefGoogle Scholar
  51. 51.
    Lindsay R, Nieves J, Formica C, Henneman E, et al (1997) Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet 350:550–555CrossRefPubMedGoogle Scholar
  52. 52.
    Luengo M, Picado C, Dei Rio L, et al (1991) Vertebral fractures in patients with rheumatoid arthritis treated with corticosteroids. Thorax 46:803–806PubMedGoogle Scholar
  53. 53.
    Lufkin EG, Wahner HW, O’Fallon WM, Hodgson SF, et al (1992) Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med 117:1–9PubMedGoogle Scholar
  54. 54.
    Lyritis GP, Tsakalakos N, Papspati I, Skarantavos G, et al (1997) The effect of a modified etidronate cyclical regimen on postmenopausal osteoporosis: a four-year study. Clin Rheumatol 16:354–360PubMedGoogle Scholar
  55. 55.
    McCloskey E, Selby P, De Takats D, Bernard J, et al (2001) Effects of clodronate on vertebral fracture risk in osteoporosis: a 1-year interim analysis. Bone 28:310–315CrossRefPubMedGoogle Scholar
  56. 56.
    McClung MR, Geusens P, Miller PD, Zippel H, et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 344:333–340PubMedGoogle Scholar
  57. 57.
    McKeogh DF (2003) Celecoxib versus diclofenac and omeprazole to prevent recurrent ulcer bleeding. N Engl J Med 348:2464–2466CrossRefGoogle Scholar
  58. 58.
    Melton LJ, Kan SH, Frye MA, et al (1989) Epidemiology of vertebral fractures in women. Am J EpidemioI 129:1000–1011Google Scholar
  59. 59.
    Meunier PJ, Slosman DO, Delmas PD, Sebert JL, et al (2002) Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteoporosis — a 2-year randomized placebo-controlled trial. J Clin Endocrinol Metab 87:2060–2066CrossRefPubMedGoogle Scholar
  60. 60.
    Naganathan V, Jones G, Nash P, et al (2000) Vertebral fracture risk with long-term corticosteroid therapy. Arch Intern Med 160:2917–2922CrossRefPubMedGoogle Scholar
  61. 61.
    Neer RM, Arnaud CD, Zanchetta JR, Prince R, et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441PubMedGoogle Scholar
  62. 62.
    Neuner JM, Zimmer, JK, Hamel MB (2003) Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures. J Am Geriatr Soc 51:483–491CrossRefPubMedGoogle Scholar
  63. 63.
    Nevitt MC, Ettinger B, Black DM (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800PubMedGoogle Scholar
  64. 64.
    Orwoll E, Ettinger M, Weiss S, et al (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610PubMedGoogle Scholar
  65. 65.
    Osteoporosis Methodology Group and Osteoporosis Research Advisory Group (2002) Meta-analyses of therapies for postmenopausal osteoporosis. Endocrine Rev 23:495–578Google Scholar
  66. 66.
    Ott SM, Chesnut CH (1989) Calcitriol treatment is not effective in postmenopausal osteoporosis. Ann Intern Med 110:267–274PubMedGoogle Scholar
  67. 67.
    Overgaard K, Hansen MA, Jensen SB, Christiansen C (1992) Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. BMJ 305:556–561PubMedGoogle Scholar
  68. 68.
    Pak CY, Sakhaee K, Adams-Huet B, Piziak V, et al (1995) Treatment of postmenopausal osteoporosis with slow-release sodium fluoride. Final report of a randomized controlled trial. Ann Intern Med 123:401–408PubMedGoogle Scholar
  69. 69.
    Recker RR, Hinders S, Davies KM, Heaney RP, et al (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11:1961–1966PubMedGoogle Scholar
  70. 70.
    Recker RR, Davies KM, Dowd RM, Heaney RP (1999) The effect of lowdose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women. A randomized controlled trial. Ann Intern Med 130:897–904PubMedGoogle Scholar
  71. 71.
    Reginster JY, Meurmans L, Zegels B, Rovati LC, et al (1998) The effect of sodium monofluorophosphate plus calcium on vertebral fracture rate in postmenopausal women with moderate osteoporosis. A randomized, controlled trial. Ann Intern Med 129:1–8PubMedGoogle Scholar
  72. 72.
    Reginster JY, Minne HW, Sorensen OH, Hooper M, et al (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 11:83–91PubMedGoogle Scholar
  73. 73.
    Reginster JY, Christiansen C, Roux C, Fechtenbaum J, et al (2001) Intermittent cyclic tiludronate in the treatment of osteoporosis. Osteoporos Int 12:169–177CrossRefPubMedGoogle Scholar
  74. 74.
    Reid DM, Hughes RA, Laan RF, et al (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European Corticosteroid-Induced Osteoporosis Treatment Study. J Bone Miner Res 15:1006–1013PubMedGoogle Scholar
  75. 75.
    Reid DM, Adami S, Devogelaer JP, Chines AA (2001) Risedronate increases bone density and reduces vertebral fracture risk within one year in men on corticosteroid therapy, Calcif Tiss Int 69:242–247CrossRefGoogle Scholar
  76. 76.
    Riggs BL, Hodgson SF, O’Fallon WM, Chao EYS, et al (1990) Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med 322:802–809PubMedGoogle Scholar
  77. 77.
    Ringe JD, Kipshoven C, Cöster A, Umbach R (1999) Therapy of established postmenopausal osteoporosis with monofluorophosphate plus calcium: dose-related effects on bone density and fracture rate. Osteoporos Int 9:171–178CrossRefPubMedGoogle Scholar
  78. 78.
    Ringe JD, Faber H, Dorst A (2001) Alendronate treatment of established primary osteoporosis in men: results of a 2-year prospective study. J Clin Endocrinol Metab 86:5252–5255PubMedGoogle Scholar
  79. 79.
    Ross PD, Davis JW, Epstein RS, et al (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923PubMedGoogle Scholar
  80. 80.
    Ryan PJ, Blake GM, Davie M, Haddaway M, et al (2000) Intermittent oral disodium pamidronate in established osteoporosis: A 2-year double-masked placebo-controlled study of efficacy and safety. Osteoporos lnt 11:171–176Google Scholar
  81. 81.
    Saag KG, Emekey R, Schnitzer TJ, et al (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 339:292–299PubMedGoogle Scholar
  82. 82.
    Sambrook PN, Kotowicz M, Hash P, et al (2003) Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium and alendronate plus calcium. J Bone Miner Res 18:919–924PubMedGoogle Scholar
  83. 83.
    Silverstein FE, Graham DY, Senior JR, et al (1995) Misoprostol reduces serious gastro-intestinal complications in patients with rheumatoid arthritis receiving non steroidal anti-inflammatory drugs. Ann Int Med 123:241–249PubMedGoogle Scholar
  84. 84.
    Steering Committee of the Physicians’ Health Study Group (1989). Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med 321:129–135Google Scholar
  85. 85.
    Storm T, Thamsborg G, Steiniche T, Genant HK, et al (1990) Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med 322:1265–1271PubMedGoogle Scholar
  86. 86.
    Tilyard MW, Spears GFS, Thomson J, Dovey S, et al (1992) Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med 326:357–362PubMedGoogle Scholar
  87. 87.
    van Staa TP, Leufkens HG, Cooper C (2001) Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 16:581–588PubMedGoogle Scholar
  88. 88.
    Wallach S, Cohen S, Reid DM, et al (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 67:277–285CrossRefPubMedGoogle Scholar
  89. 89.
    Walsh LJ, Wong CA, Pringle M, Tattersfield AE (1996) Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross-sectional study. BMJ 313:344–346PubMedGoogle Scholar
  90. 90.
    Watts NB, Harris ST, Genant HK, Wasnich RD, et al (1990) Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 323:73–79PubMedGoogle Scholar
  91. 91.
    WHO study group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report series. WHO, GenevaGoogle Scholar
  92. 92.
    Wimalawansa SJ (1998) A four-year randomized controlled trial of hormone replacement and bisphosphonate, alone or in combination, in women with postmenopausal osteoporosis. Am J Med 104:219–226CrossRefPubMedGoogle Scholar
  93. 93.
    Windeler J, Lange S (1995) Events per person year, a dubious concept. BMJ 310:454–456PubMedGoogle Scholar
  94. 94.
    Wong CA, Walsh LJ, Smith CJP, et al (2000) Inhaled corticosteroid use and bone mineral density in patients with asthma. Lancet 355:1399–1403CrossRefPubMedGoogle Scholar
  95. 95.
    Writing Group for the Women’s Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • K. Lippuner
    • 1
  1. 1.Osteoporosis PoliclinicUniversity Hospital of BerneBerneSwitzerland

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