OSTEOPOROSIS (BONE DEMINERALIZATION): CURRENT TREATMENT FOR POSTMENOPAUSAL WOMEN - For Professionals

Osteoporosis is a medical condition in which the bone becomes fragile and prone to breakage as a result of loss of tissue (mineral content). there are various causes that result from deficiency of calcium or vitamin D, but typically from hormonal changes.

It can affect both males and females, but it is most likely to occur in women after menopause, because of the sudden decrease in estrogen, the hormone that normally protects against osteoporosis.

Current guidelines on the pharmacologic treatment of osteoporosis in postmenopausal women aim to encourage clinicians to boost rates of screening and treatment for the condition.

Treatment

As a start, lifestyle and nutritional optimization for bone health — especially calcium and vitamin D — are recommended for all postmenopausal women. 

As in the past, bisphosphonates and denosumab (a human monoclonal antibody) are still advised as first-line therapies.

Bisphosphonates are a family of drugs used to treat osteoporosis. They include agents like alendronate (Fosamax ®), etidronate (Didrocal ®), risedronate (Actonel ®) and zoledronic acid (Aclasta®), alendronate with Vit D (Fosavance®). Bisphosphonates work by binding to the surfaces of the bones and slow down the bone resorping action of the osteoclasts (bone-eroding cells). This allows the osteoblasts (bone-building cells) to work more effectively.

Currently it is recommended to use anabolic treatments — teriparatide (a recombinant protein form of parathyroid hormone consisting of the first (N-terminus) 34 amino acids, which is the bioactive portion of the hormone.) or abaloparatide (a parathyroid hormone-related protein (PTHrP) analog drug used to treat osteoporosis. Like the related drug teriparatide, and unlike bisphosphonates) (Tymlos) — as first-line therapy for patients with very severe osteoporosis, multiple fractures, and/or very low bone density.

The new recommendation means that we get intervention early, as the effects are quicker than they are with bisphosphonates.

For women who have been on bisphosphonates for 3 to 5 years, fracture risk should be assessed.

Following reassessment, women who have a low-to-moderate risk of fracture should be prescribed a "bisphosphonate holiday."

All women taking osteoporosis therapies — except anabolics — should consume calcium and vitamin D in their diet or by taking supplements. 

Monitoring of bone mineral density (BMD) for high-risk patients with low BMD should take place every 1 to 3 years. 

Risks associated with Osteoporosis Treatments

There is the particular concern about atypical femoral fractures that have been linked to bisphosphonates. Some of the recent data suggest that the risk for atypical femoral fractures with bisphosphonates remains quite low. However, certain factors do increase that risk though, especially longer duration of therapy. "That's one of the reasons a drug holiday in many individuals who have been successfully treated for up to 3 years with a bisphosphonate is advocated.