Osteoporosis diagnosis and treatment

Czech version

Authors: I. Kučerová
Authors‘ workplace: Osteocentrum, Nemocnice České Budějovice, a. s.
Published in: Kardiol Rev Int Med 2014, 16(5): 402-409
Category: Internal Medicine

Overview

Osteoporosis is a progressive systemic skeletal disease, characterised by loss of bone mass and disorder of bone microarchitecture. Consequently, the bone is prone to fractures. About 30% of women and 20% of men will suffer from an osteoporotic fracture in their lifespan. Over the last few decades, a rise in the osteoporotic complications has been observed. The disease has become an important medical, social and economic burden. With increasing life expectancy, the number of vertebral body fractures and also proximal femoral bone and other non‑vertebral fractures has been growing. Osteoporotic fractures worsen the quality of life, increase the need for hospitalisation and even mortality. The first treatment goal is to decrease the risk of first fracture as part of primary prevention and provide treatment to patients who have already suffered their first low trauma fracture, using secondary prevention methods to avoid repeated fractures. The most useful antiresorptive drugs are bisphosphonates. They are stored in bones and reduce the risk of fracture by 40 to 60 percent. Another very potent antiresorptive drug with a different mode of action is denosumab. Another therapeutic option is the osteoanabolic treatment, with a significant benefit for patients with serious forms of the disease. The article presents an overview of diagnostic and therapeutic possibilities.

Keywords:
osteoporosis – diagnostics of osteoporosis – primary and secondary prevention of fractures

Sources

1. Consensus development konference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 1993; 94: 646– 650.

2. Svedbom A, Hernlund E, Ivergård M et al. Osteoporosis in the European Union: a compendium of country‑ specific reports. Arch Osteoporos 2013; 8: 137. doi: 10.1007/ s11657‑ 013‑ 0137‑ 0.

3. Klotzbuecher CM, Ross PD, Landsman PB et al. Patients with prior fractures have an Increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000; 15: 721– 739.

4. Johnell O, Kanis JA, Odén A et al. Fracture risk following an osteoporotic fracture. Osteoporos Int 2004; 15: 175– 179.

5.Center JR, Nguyen TV, Schneider D et al. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999; 353: 878– 882.

6. Bliuc D, Nguyen ND, Milch VE et al. Mortality risk associated with low‑ trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009; 301: 513– 521. doi: 10.1001/ jama.2009.50.

7. Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med 1997; 103: 12S‑ 17S.

8. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. Geneva, World Health Organization 1994; 843: 1– 129.

9. ISCD Combined Official Positions. Official Positions of the International Society for Clinical Densitometry 2013. [online] Available from: http:/ / www.iscd.org/ official‑ positions/ 2013– iscd‑official‑ positions‑ adult/

10. van Brussel MS, Lems WF. Clinical relevance of diagnosing vertebral fractures by vertebral fracture assessment. Curr Osteoporos Rep 2009; 7: 103– 106.

11. Vasikaran S, Eastell R, Bruyére O et al. Markers of bone turnover for prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 2011; 22: 391– 420. doi: 10.1007/ s00198‑ 010‑ 1501‑ 1.

12. Szulc P, Delmas D. Biochemical markers of bone turnover: potential use in the investigation an management of postmenopausal osteoporosis. Osteoporos Int 2008; 19: 1683– 1704. doi: 10.1007/ s00198‑ 008‑ 0660‑ 9.

13. Štěpán J. Kvalita kosti: které účinky můžeme monitorovat a co to předpokládá? Osteologický bulletin 2003; 3: 75– 81.

14. Guanabens N. Clinical application of bone turnover marker measurement. Bristol, 3rd Joint Meeting of the ECTS 2011.

15. Eastell R, Barton I, Hannon RA et al. Relationship of early changes in bone resorption to the reduction in fracture risk with risedronate. J Bone Miner Res 2003; 18: 1051– 1056.

16. Arlot M, Meunier PJ, Boivin G et al. Differential effects of teriparatide and alendronate on bone remodeling in postmenopausal women assessed by histomorphometric parameters. J Bone Miner Res 2005; 20: 1244– 1253.

17. Black DM, Schwartz AV, Ensrud KE et al. Effects of continuing or stopping alendronate after 5 years of treatment.The Fracture Intervention Trial Long‑term Extension (FLEX): a randomized trial. JAMA 2006; 296: 2927– 2938.

18. Kanis JA on behalf of the WHO Scientific Group. Assessment of osteoporosis at the primary health‑ care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK: WHO Collaborating Centre 2008.

19. Leslie WD, Lix LM, Johansson H et al. Spine‑ hip discordance and fracture risk assessment: a physician‑ friendly FRAX enhancement.Osteoporos Int 2011; 22: 839– 847. doi: 10.1007/ s00198‑ 010‑ 1461‑ 5.

20. Kemmler W, Häberle L, von Stengel S. Effects of exercise on fracture reduction in older adults: A systematic review and meta‑analysis. Osteoporos Int 2013; 24: 1937– 1950. doi: 10.1007/ s00198‑ 012‑ 2248‑ 7.

21. Kazda A, Broulík P. Nutrice a osteoporóza. Osteologický bulletin 2006; 11: 95– 103.

22. Bayer M, Palička V, Rosa J et al. Doporučené postupy pro diagnostiku a terapii postmenopauzální osteoporózy II, část první. Osteologický bulletin 2007; 12: 24– 33.

23. Body JJ, Bergmann P, Boonen S et al. Extraskeletal benefits and risks of calcium, vitamin D and anti‑osteoporosis medications. Osteoporos Int 2012; 23 (Suppl 1): S1– 23.

24. Lewis JR, Calver J, Zhu K et al. Calcium supplementation and the risks of atherosclerotic vascular disease in older women: results of a 5‑year RCTand a 4.5‑year follow‑up. J Bone Miner Res 2011; 26: 35– 41. doi: 10.1002/ jbmr.176.

25. Horák P. Alfakalcidol v léčbě osteoporózy. Remedia 2008; 18: 448– 445.

26. Kanis JA, McCloskey EV, Johansson H et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013; 24: 23– 57. doi: 10.1007/ s00198‑ 012‑ 2074‑ y.

27. Bayer M, Jeníček J, Kučerová I et al. Doporučené postupy pro diagnostiku a terapii postmenopauzální osteoporózy II, část druhá. Osteologický bulletin 2007; 12: 74– 81.

28. Bayer M, Horák P, Kutílek S et al. Doporučené postupy pro diagnostiku a terapii postmenopauzální osteoporózy II, dodatek. Osteologický bulletin 2010; 15: 165– 168.

29. De Villiers TJ, Pines A, Panay N et al. Updated 2013 International Menopause Society recommendations on menopausal hormone therapy and preventive strategies for midlife health. Climacteric 2013; 16: 316– 337. doi: 10.3109/ 13697137.2013.795683.

30. Fait T. Postavení tibolonu v současné klimakterické medicíně. Klimakterická Medicína 2012; 17: 12– 17.

31. Ettinger B, Black DM, Mitlak BH et al. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3‑year randomized clinical trial. JAMA 1999; 282: 637– 645.

32. Delmas PD, Genant HK, Crans GG et al. Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 2003; 33: 522– 532.

33. Russell RG, Watts NB, Ebetino FH et al. Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 2008; 19: 733– 759. doi: 10.1007/ s00198‑ 007‑ 0540‑ 8.

34. Black DM, Thompson DE, Bauer DC et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention trial. J Clin Endocrinol Metab 2000; 85: 4118– 4124.

35. Chavassieux PM, Arlot ME, Reda C et al. Histomorphometric assessment of the long‑term effects of alendronate on bone quality and remodeling in patients with osteoporosis. J Clin Invest 1997; 100: 1475– 1480.

36. Harris ST, Watts NB, Genant HK et al. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999; 282: 1344– 1352.

37. McClung MR, Geusens P, Miller PD et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001; 344: 333– 340.

38. Růžičková O. Ibandronát – účinnost, která v čase neklesá. Farmakoterapie 2011; 7: 327– 334.

39. Cranney A, Wells GA, Yetisir E et al. Ibandronate for the prevention of nonvertebral fractures: a pooled analysis of individual patient data. Osteoporos Int 2009; 20: 291– 297. doi: 10.1007/ s00198‑ 008‑ 0653‑ 8.

40. Black DM, Delmas PD, Eastell R et al. Once‑yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007; 356: 1809– 1822.

41. Lyles KW, Colon‑ Emeric CS, Magaziner JS et al. Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture. N Engl J Med 2007; 357: 1799– 1809.

42. Meunier PJ, Roux C, Seeman E et al. The effects of stroncium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004; 350: 459– 468.

43. Reginster JY, Seeman E, De Vernejoul MC et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) Study. J Clin Endocrinol Metab 2005; 90: 2816– 2822.

44. Seeman E, Vellas B, Benhamou C et al. Strontium ranelate reduces the risk of vertebral and non‑vertebral fractures in women eighty years of age and older. J Bone Miner Res 2006; 21: 1113– 1120.

45. Reginster JY, Kaufman JM, Goemaere S et al. Maintenance of antifracture efficacy over 10 years with strontium ranelate in postmenopausal osteoporosis. Osteoporos Int 2012; 23: 1115– 1122. doi: 10.1007/ s00198‑ 011‑ 1847‑ z.

46. Boonen S, Adachi JD, Man Z et al. Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab 2011; 96: 1727– 1736. doi: 10.1210/ jc.2010‑ 2784.

47. Seeman E, Delmas PD, Hanley DA et al. Microarchitectural deterioration of cortical and trabecular bone: differing effects of denosumab and alendronate. J Bone Miner Res 2010; 25: 1886– 1894. doi: 10.1002/ jbmr.81.

48. Reginster JY, Neuprez A, Beaudart C et al. Antiresorptive drugs beyond bisphosphonates and selective oestrogen receptor modulators for the management of postmenopausal steoporosis. Drugs Aging 2014; 31: 413– 424. doi: 10.1007/ s40266‑ 014‑ 0179‑ z.

49. Reid IR, Miller PD, Brown JP et al. Effects of denosumab on bone histomorphometry: the FREEDOM and STAND studies. J Bone Miner Res 2010; 25: 2256– 2265. doi: 10.1002/ jbmr.149.

50. Cooper C, Reginster JY, Cortet B et al. Long‑term treatment of osteoporosis in postmenopausal Women: a review from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis ( ESCEO) and the International Osteoporosis Foundatinon (IOF). Curr Med Res Opin 2012; 28: 475– 491. doi: 10.1185/ 03007995.2012.663750.

51. Roux C, Briot K. How long should we treat? Osteoporos Int 2014; 25: 1659– 1666. doi: 10.1007/ s00198‑ 013‑ 2433‑ 3.

52. Curtis JR, Westfall AO, Cheng H et al. Risk of hip fracture after bisphosphonate discontinuation: implications for a drug holiday. Osteoporos Int 2008; 19: 1613– 1620. doi: 10.1007/ s00198‑ 008‑ 0604‑ 4.

53. Papapoulos S, Lippuner K, Roux C et al. Eight years of denosumab treatment in postmenopausal women with osteoporosis: results from the first five years of the FREEDOM Extension. Baltimore: ASBMR 2013.

54. Neer RM, Arnaut CD, Zanchetta JR et al. Effect of parathyroid hormone (1– 34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434– 1441.

55. Jiang Y, Zhao JJ, Mitlak BH et al. Recombinant human parathyroid hormone (1– 34) [teriparatide] improves both cortical and cancellous bone structure. J Bone Miner Res 2003; 18: 1932– 1941.

56. Stepan JJ, Burr DB, Li J et al. Histomorphometric changes by teriparatide in alendronate‑ pretreated women with osteoporosis. Osteoporos Int 2010; 21: 2027– 2036. doi: 10.1007/ s00198‑ 009‑ 1168‑ 7.