J Korean Med Assoc.  2016 Nov;59(11):847-856. 10.5124/jkma.2016.59.11.847.

Pharmacologic treatment of osteoporosis

• Min YK

• KMID: 2358432
• DOI: http://doi.org/10.5124/jkma.2016.59.11.847

Abstract

The objectives of this article are to review current pharmacologic approaches for the treatment of osteoporosis in Korea. Calcium and vitamin D supplementation are necessary for osteoporotic patients with inadequate calcium intake and low vitamin D nutritional status, which is a risk factor of osteoporosis. Several pharmacologic therapies are available for treatment of osteoporosis. Antiresorptive agents, bisphosphonates, selective estrogen receptor modulators, denosumab, estrogens, and tibolone are the basis of therapy. Antiresorptive medications reduce the rates of bone remodeling. Several drugs have shown their ability to reduce vertebral and/or nonvertebral fractures in patients with osteoporosis. Bisphosphonates that reduced bone loss and fragility are usually the mainstay of the treatment of osteoporosis. The recently registered denosumab shows similar anti-fracture efficacy by neutralizing receptor activator of nuclear factor-κB ligand, however, marked differences in reversibility can be observed between the two drugs. The anabolic agents, teriparatide, stimulates new bone formation, increases bone density, and reduces fractures. Other treatment options such as hormone replacement therapy, tibolone, raloxifene, and bazedoxifene are also reviewed in this article. Pharmacologic treatments of osteoporosis are associated with adverse effects, but the benefits generally far surpass the risks.

Keyword

Osteoporosis; Calcium; Vitamin D; Antiresorptive agents; Anabolic agents

MeSH Terms

Anabolic Agents
Bone Density
Bone Density Conservation Agents
Bone Remodeling
Calcium
Denosumab
Diphosphonates
Estrogens
Hormone Replacement Therapy
Humans
Korea
Nutritional Status
Osteogenesis
Osteoporosis*
Raloxifene Hydrochloride
Risk Factors
Selective Estrogen Receptor Modulators
Teriparatide
Vitamin D
Anabolic Agents
Bone Density Conservation Agents
Calcium
Denosumab
Diphosphonates
Estrogens
Raloxifene Hydrochloride
Selective Estrogen Receptor Modulators
Teriparatide
Vitamin D

Figure

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  Figure 1 Proposed algorithm for the selection of candidates for drug holidays and principles of monitoring. BMD, bone mineral density. a)T-score at any site still ≤2.5 after bisphosphonate therapy, previous fracture of the hip or spine, and secondary osteoporosis from chronic diseases or medication. Adapted from Lee SH et al. J Bone Metab 2015;22:167-174, according to the Creative Commons license [25].

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