Long-Term Treatment of Postmenopausal Osteoporosis

Abstract

Osteoporosis is an incurable chronic condition, like heart disease, diabetes, or hypertension. A large gap currently exists in the primary prevention of fractures, and studies show that an estimated 80% to 90% of adults do not receive appropriate osteoporosis management even in the secondary prevention setting. Case finding strategies have been developed and effective pharmacological interventions are available. This publication addresses how best to use the pharmacological options available for postmenopausal osteoporosis to provide lifelong fracture protection in patients at high and very high risk of fracture. The benefit of osteoporosis therapies far outweighs the rare risks.

Keywords: Denosumab; Diphosphonates; Duration of therapy; Osteoporosis, postmenopausal.

Fig. 1

Mechanism of action of osteoporosis therapies. BP, bisphosphonate; DMAb, denosumab; OPG, osteoprotegerin; PTH, parathyroid hormone; RANK, receptor activator of nuclear factor kappa-B; RANKL, receptor activator of nuclear factor kappa-B ligand; RMAb, romosozumab; TPTD, teriparatide.

Fig. 2

Putting the risks of osteoporotic fracture vs. rare adverse events into perspective. Adapted from Brown et al. [48]. DMAb-AFF, denosumab-associated atypical subtrochanteric and diaphyseal femur fracture; Bis-AFF, bisphosphonate-associated atypical subtrochanteric and diaphyseal femur fracture; DMAb-ONJ, denosumab-associated osteonecrosis of the jaw; Bis-ONJ, bisphosphonate-associated osteonecrosis of the jaw; MVA, motor vehicle accident; MOF, major osteoporotic fracture. ^a10-Year risk of major osteoporotic fracture by Canadian Fracture Risk Assessment Tool.