[Therapy of osteoporosis]

Abstract

The different possibilities of the therapy are discussed. Most importantly, calcium should be supplemented prophylactically in sufficient doses (1-1.5 g/d). Vit. D may be added in the elderly patient. In the pre- and postmenopause, an estrogen/gestagen administration is indicated. Estrogen is also the treatment of the first choice in the therapy of the manifest osteoporosis. Calcitonin, which has an analgetic effect as well, is currently recommended as an inhibitor of bone absorption. Starting with daily injections of 100 IU of calcitonin followed by 50 IU injections three times a week improve feeling and condition of the patient. Bisphosphonates, which have excellent effects on bone absorption, are not yet permitted for the osteoporosis therapy. Vit. D metabolites (alfacalcidol) have a particular beneficial effect on the osteoporosis induced by glucocorticoids. Sodium fluoride and monofluorophosphate are the only substances available that lead to a real bone build on. About 0.5 mg/kg body weight of fluoride should be administered. 30% of the patients do not respond to this treatment and side effects have to be observed. Growth hormone and parathormon may be useful drugs in the future. The drug treatment of osteoporosis has to be accompanied by a proper pain therapy as well as a physiotherapeutic, orthopedic and psychososical care.