Management of Osteoporosis: Who to Treat, What to Use, and for How Long?

Kim, Sang Wan

Abstract

Osteoporosis is a huge global problem both socially and economically- in the South Korea alone, in 2011 66 million dollar was spent on treatment and social care of the 773,000 osteoporotic patients- and therefore variable preventative and therapeutic approaches are keys to managing this problem within the aging population of today. This review discusses the main issues- who should be treated, what pharmacological agents should be used, and how long they should be administered-surrounding current osteoporosis management. Identifying patients at risk is challenging before they develop a fracture. Probability of fracture based on the Korea-adapted WHO algorithm should be used in making decision of treatment. Though bisphosphonates are the most commonly used drugs for the treatment of osteoporosis, the majority of data on fracture effect is from studies of 3 or 4 years. The long-term treatment should balance fracture efficacy against the risk of adverse events. Although evidence is limited regarding the risk of fracture with the continuation of bisphosphonate therapy, it might be useful to continue treat osteoporosis up to 10 years, to prevent vertebral fractures in the high risk elderly. There are currently no data to guide clinicians in determining who should continue treatment after 5 years. The duration of treatment and the agent selected should be based on individual assessment of risks and benefits and on patient preference.