Episode 19: Osteoporosis: Treating for Fracture Reduction
Options in treatment, which ones have evidence of non-vertebral fracture and the absolute benefits of those treatments. We discuss reliability of monitoring bone density of patients on therapy and the duration of therapy.
1) Evidence for fracture reduction
There is good evidence from randomized controlled trials (RCTs) that alendronate, etidronate, ibandronate, risedronate, calcitonin, 1-34 PTH, and raloxifene prevent vertebral fractures compared with placebo.
There is good evidence from RCTs that risedronate and alendronate prevent both nonvertebral and hip fractures compared with placebo.
There is good evidence that zoledronic acid prevents vertebral and nonvertebral fractures, and fair evidence that it prevents hip fractures.
Agency for healthcare research and quality – report
2) Calcitonin appears to be effective in the management of acute pain associated with acute osteoporotic vertebral compression fractures by shortening time to mobilization
Osteoporosis Int 2005;16:1281-90
3) Relative and absolute benefits from using alendronate for 2-3 years
45% reduction in vertebral fractures – 2% absolute reduction for primary and 6% for secondary
20% reduction in non-vertebral – just secondary prevention – 2% absolute reduction
50% reduction in hip fractures – just secondary prevention – 1% absolute reduction