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A review article in the Medical Letter highlights appropriate use and limitations of bisphosphonates, denosumab, and other osteoporosis treatment, along with the associated costs.
Drugs For Postmenopausal Osteoporosis. The Medical Letter on Drugs and Therapeutics. (2014)56(1452):91-96. September 29, 2014
Abramowicz M. Osteoporosis: A Big Problem.The Medical Letter on Drugs and Therapeutics. September 11, 2014
Physicians who routinely treat osteoporosis are no doubt familiar with the standard of care, but some may want to update themselves with the review article above.
It generally follows the guidelines of the American Association of Clinical Endocrinologists, National Osteoporosis Foundation, World Health Organization, US Preventive Services Task Force, Cochrane Database, selected meta-analyses, and studies such as the Women’s Health Initiative.
The review authors make recommendations for the appropriate use and limitations of bisphosphonates, denosumab, teriparatide, and estrogen receptor agonists, the associated costs, and tradeoffs of effectiveness, cost, and adverse effects. All have been shown to reduce the risk of vertebral fractures, and most-but not all-have been shown to reduce the risk of non-vertebral fractures.
An adequate intake of calcium and vitamin D is essential for women taking antiresorptive drugs. This can be done by diet alone, but as the selected nutrition tables in The Medical Letter show, that’s not easy. Most women will require supplements.
In a blog commentary, editor Mark Abramowicz MD notes that hip fractures have a 1-year mortality rate of 17% for women. Less than half of all women with postmenopausal osteoporosis are diagnosed, and only 15% are treated. “So our work is cut out for us,” he wrote.