Several but not all studies show decreases in vertebral fracture risk. A few reports have suggested that alfacalcidol and calcitriol exert a direct action on muscle strength and decreases the likelihood of falling in elderly subjects. Most guidelines recommend against using active vitamin D one alpha or calcitriol in the treatment of osteoporosis without clear indication of renal failure or vitamin D synthesis defects or other clear indications.
Newer therapies continue to be developed and introduced for the management of osteoporosis. They can be divided into drugs with improved formulation and potency such as zoledronic acid with once yearly intravenous administration and ibandronate with once monthly oral administration or quarterly intravenous administration.
These drugs could provide better adherence and compliance to therapy.
Drugs with newer therapy targets that improve bone formation include teriparatide and strontium ranelate. They appear to have a dual action of improving bone formation and slowing down bone resorption. Other therapies under evaluation have a specific molecular target resulting in decreasing bone resorption or enhancing bone formation.
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Other drugs under investigation are the cathepsin K inhibitors, that inhibit cathepsin K, which is an enzyme secreted by osteclasts to increase bone resorption. Newer bone forming agents are alson in development. The action of osteoblasts is regulated by special proteins called Wnt that interact with special receptors on the surface of osteoblasts called LRP5 and LRP6. This interaction stimulates the activity of osteoblasts in bone formation through intracellular factors like axin and B-catenin.
Sclerostin is a factor that blocks the interaction of Wnt with LRP receptors, slowing bone formation. A new drug under testing is an antisclerostin antibody that would therefore increase bone forming activities of the osteoblast. With the wide availability of different therapies and the development of even more therapies in the future, the choice of therapy may become more difficult for practitioners.
However, like many other chronic diseases, alternative therapies provide more flexibility and individualized choices.
There are, however, certain criteria and basic rules for the choice of treatment that practicing physician needs to take in account, including the level of evidence for efficacy of a certain agent. Trials on different therapeutic agents have been done. Randomized controlled trials RCTs or metanalyses of a number of RCTs for a specific agent are considered of highest value. Comparison between agents, however, is not possible based on those studies because of different populations and therefore different risks for fractures.
Direct head-to-head comparisons between agents are rare and are very difficult to do, as it would require a very long duration and large number of subjects to show a measurable effect on fracture risk. Therefore, it is our recommendation to seek the best evidence for each agent, especially in terms of efficacy against vertebral, non-vertebral and hip fractures.
Appendix 1. Recommended daily elemental calcium intake for peri- and postmenopausal women. Appendix 2. Appendix 3. Recommended daily intake of Vitamin D. Appendix 4. Calcium content of foods. Appendix 5. Agents Approved for the Management of Osteoporosis. Appendix 6. Appendix 7. The authors report no funding support nor conflict of interest. National Center for Biotechnology Information , U. Journal List Ann Saudi Med v. Ann Saudi Med.
Causes, mechanisms and management of paediatric osteoporosis
Author information Article notes Copyright and License information Disclaimer. Correspondence: Dr. Accepted Oct. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC.
Abstract Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. What is new in this report? An emphasis on the role of vitamin D deficiency and the need for correction. A re-emphasis on the role of clinical risk factors in choosing patients for treatment. A review of new international guidelines.
A review of newer therapies. Definition Osteoporosis is a progressive, systemic skeletal disorder characterized by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. The Burden of Osteoporosis In The Region Today, osteoporosis is a major public health problem that has both a medical and economic impact especially in developed countries.
Regional Bone Mineral Density Data Osteopenia and osteoporosis are more common in our local population than in Western countries. Open in a separate window.
Figure 1. Local Fracture Data Local and regional information about osteoporosis and fracture rates is sparse.
- Frontiers | New Insights Into Monogenic Causes of Osteoporosis | Endocrinology.
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Table 2 Proximal femur annual fracture rates per population in Saudi subjects seen in Riyadh region from Nuaim et al with permission. Table 3 World Health Organization definition of osteoporosis. The tool was not verified in local studies. Some of the risk factors included are not well defined such as the "ever use of steroids" The risk for falling due to muscle weakness or visual impairment is not included as a risk factor, though was found to be quite important by other studies.
Using Risk Factors in the Local Population One important issue is whether generally used risk factors for osteoporosis or fractures are valid for a specific population. Screening for Osteoporosis in Postmenopausal Women and Elderly Men Some international guidelines for osteoporosis screening recommend BMD testing for all women age 65 years or older, and for postmenopausal women under age 65 years especially years who have one or more additional high-risk factors for osteoporosis.
Clinical Manifestations and Complications Osteoporosis is a silent disease, as bone loss occurs without symptoms.
Osteoporosis in rheumatic diseases
Prevention of Osteoporosis Prevention is the most important measure in addressing low BMDs in the youth and in women during reproductive age. Initiatives should be directed at the following measures: Optimal nutrition in the youth to achieve high peak bone mass, including adequate intake of calcium and vitamin D. Regular weight-bearing exercise. Avoidance of tobacco smoking and alcohol intake. Osteopenia and Fractures Although patients with lower BMD are at high risk of fractures, studies have shown that the largest number of osteoporotic fractures occurred among those with osteopenia BMD -1 to Specific Types of Osteoporosis Premenopausal osteoporosis The present evidence does not support screening for osteoporosis in premenopausal women in the general population.
Replacement of gonadal steroids in men if deficient. Women with premature hypogonadism, should be considered for estrogen therapy. Prevention and management of transplant-induced osteoporosis The literature regarding prevention and treatement of transplant-associated bone loss is plagued by relatively small numbers of patients with insufficient power to detect significant differences in BMD, differing immunosuppressant regimens, no randomization, or randomization at varying intervals following transplantation.
Female Athlete Triad
Treatment of osteoporosis in adolescents Throughout childhood and adolescence, the skeleton changes in both size and shape. Treatment of osteoporosis in chronic renal failure and end-stage renal disease The diagnosis of osteoporosis in chronic renal failure is not easy to make due to the confounding effects of renal osteodystrophy and superimposed osteomalacia that may also result in fractures and low BMD. All patients should receive recommended the dose of vitamin D. Pharmacotherapy of Osteoporosis The most commonly used agents in Europe and the US are listed and briefly discussed.
Selective estrogen-receptor modulators Selective estrogen-receptor modulators SERMs are non-steroidal agents that bind to the estrogen receptor and act as estrogen agonists or antagonists, depending on the target tissue. Bisphosphonates Bisphosphonates have a strong affinity for bone apatite, which is the basis for their clinical use.
Related Chapter 18, The Spectrum of Pediatric Osteoporosis
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