Citation

Reid IR. J. Intern. Med. 2014; 277(6): 690-706.

Affiliation

University of Auckland and Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand.

Copyright

(Copyright © 2014, John Wiley and Sons)

DOI

10.1111/joim.12339

PMID

25495429

Abstract

There is an increasing number of effective therapies for fracture prevention in adults at risk of osteoporosis. However, shortcomings in the evidence underpinning our management of osteoporosis still exist. Evidence of anti-fracture efficacy in the groups of patients who most commonly use calcium and vitamin D supplements is lacking, the safety of calcium supplements is in doubt, and the safety and efficacy of high doses of vitamin D give cause for concern. Alendronate, risedronate, zoledronate and denosumab have been shown to prevent spine, non-spine and hip fractures; in addition, teriparatide and strontium ranelate prevent both spine and non-spine fractures, and raloxifene and ibandronate prevent spine fractures. However, most trials provide little information regarding long-term efficacy or safety. A particular concern at present is the possibility that oral bisphosphonates might cause atypical femoral fractures. Observational data suggest that the incidence of this type of fracture increases steeply with duration of bisphosphonate use, resulting in concern that the benefit-risk balance may become negative in the long term, particularly in patients in whom the fracture risk is not high. Therefore, reappraisal of ongoing use of bisphosphonates after about 5 years is endorsed by expert consensus, and 'drug holidays' should be considered at this time. Further studies are needed to guide clinical practice in this area. This article is protected by copyright. All rights reserved.

Language: en