Osteoporosis: Current Management Guidelines.
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Date
2013-05
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Abstract
Osteoporosis is a multifactorial progressive skeletal disorder characterized by reduced bone mass and deterioration of bone
microarchitecture. Fragility fractures, the consequence of osteoporosis, are responsible for excess mortality, morbidity, chronic
pain, admission to hospitals and economic costs. Approximately 1.6 million hip fractures occur each year worldwide and the
incidence is set to increase to 6.3 million by 2050. Preventive measures should be started at an early age and should include
smoking cessation and weight-bearing exercises. Pharmacologic prevention methods include calcium supplementation
and administration of raloxifene or bisphosphonates. No treatment can completely reverse established osteoporosis. Early
intervention can prevent osteoporosis in most people. For patients with established osteoporosis, medical intervention can halt its
progression. Currently available therapies include bisphosphonates, selective estrogen receptor modulators (SERMs), hormone
replacement therapy (HRT), denosumab, teriparatide, calcitonin and strontium ranelate. Cathepsin K inhibitors (balicatib and
odanacatib) are among recent drugs under development. Saracatinib, a novel orally available competitive inhibitor of Src kinase
has been shown to inhibit bone resorption in vitro. Lasofoxifene, bazedoxifene and arzoxifene are new SERMs in late-stage
treatment trials. Nonpharmacological measures are required when patients experience adverse effects because of drug therapy,
when symptoms are not controlled by drug therapy alone or when patient is not willing to take drugs for a prolonged duration.
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Keywords
Fragility fractures, bisphosphonates, SERMs, Src kinase
Citation
Singh Harmanjit, Goyal Manoj, Singh Jasbir. Osteoporosis: Current Management Guidelines. Indian Journal of Clinical Practice. 2013 May; 23(12): 842-851.