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Long-term treatment of osteoporosis in postmenopausal women: a review from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF)

Long-term treatment of osteoporosis in postmenopausal women: a review from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF)
Long-term treatment of osteoporosis in postmenopausal women: a review from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF)
Introduction: Postmenopausal osteoporosis is a chronic disease requiring treatment that balances long-term fracture efficacy against risk.

Methods: We reviewed the efficacy and safety of calcium and vitamin D, the selective estrogen receptor modulators (SERMs), the bisphosphonates, denosumab, and strontium ranelate in studies of 3 years or longer.

Results: Six trials lasted for 5 years, and seven went beyond that. The evidence beyond 5 years is generally weak, mainly due to methodological issues (open-label design, small samples, or absence of placebo control). Although calcium and vitamin D appear to be beneficial, the data are insufficient to evaluate benefits and risk beyond 3 years. The fracture efficacy of SERMs beyond 5 years is not known, though increases in bone mineral density (BMD) appear to be maintained. The SERMs have good long-term safety, including protective effects against breast cancer. The bisphosphonates have established fracture efficacy to 3 years, and 4 or 5 years with alendronate and risedronate. The evidence beyond 5 years indicates sustained increases in BMD. The safety of the bisphosphonates does not appear to be modified with time, with the possible exceptions of atypical subtrochanteric fracture and other events of unknown frequency. Denosumab has been tested up to 5 years, with continued increased in BMD and no reported safety issues. There is evidence for fracture efficacy of strontium ranelate, and sustained increases in BMD over 10 years. Strontium ranelate has good long-term safety.

Conclusion: Robust long-term studies are relatively rare for the osteoporosis treatments, and generally show maintenance of BMD and, for some agents, an additional reduction in fracture incidence.
0300-7995
475-491
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Reginster, J-Y.
a27516fb-9123-4b22-b64c-9beea93f1fdc
Cortet, B.
1ca3d953-f9fe-4fba-a189-7f610a1c8b09
Diaz-Curiel, M.
2c0d50ea-86b5-4722-8cfd-cb0fa123865b
Lorenc, R.S.
2068f89b-949e-47d0-aea8-ce537c87723c
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Reginster, J-Y.
a27516fb-9123-4b22-b64c-9beea93f1fdc
Cortet, B.
1ca3d953-f9fe-4fba-a189-7f610a1c8b09
Diaz-Curiel, M.
2c0d50ea-86b5-4722-8cfd-cb0fa123865b
Lorenc, R.S.
2068f89b-949e-47d0-aea8-ce537c87723c
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7

Cooper, C., Reginster, J-Y., Cortet, B., Diaz-Curiel, M., Lorenc, R.S., Kanis, J.A. and Rizzoli, R. (2012) Long-term treatment of osteoporosis in postmenopausal women: a review from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF). Current Medical Research and Opinion, 28 (3), 475-491. (doi:10.1185/03007995.2012.663750). (PMID:22356102)

Record type: Article

Abstract

Introduction: Postmenopausal osteoporosis is a chronic disease requiring treatment that balances long-term fracture efficacy against risk.

Methods: We reviewed the efficacy and safety of calcium and vitamin D, the selective estrogen receptor modulators (SERMs), the bisphosphonates, denosumab, and strontium ranelate in studies of 3 years or longer.

Results: Six trials lasted for 5 years, and seven went beyond that. The evidence beyond 5 years is generally weak, mainly due to methodological issues (open-label design, small samples, or absence of placebo control). Although calcium and vitamin D appear to be beneficial, the data are insufficient to evaluate benefits and risk beyond 3 years. The fracture efficacy of SERMs beyond 5 years is not known, though increases in bone mineral density (BMD) appear to be maintained. The SERMs have good long-term safety, including protective effects against breast cancer. The bisphosphonates have established fracture efficacy to 3 years, and 4 or 5 years with alendronate and risedronate. The evidence beyond 5 years indicates sustained increases in BMD. The safety of the bisphosphonates does not appear to be modified with time, with the possible exceptions of atypical subtrochanteric fracture and other events of unknown frequency. Denosumab has been tested up to 5 years, with continued increased in BMD and no reported safety issues. There is evidence for fracture efficacy of strontium ranelate, and sustained increases in BMD over 10 years. Strontium ranelate has good long-term safety.

Conclusion: Robust long-term studies are relatively rare for the osteoporosis treatments, and generally show maintenance of BMD and, for some agents, an additional reduction in fracture incidence.

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Published date: March 2012
Organisations: Faculty of Health Sciences

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Local EPrints ID: 339081
URI: http://eprints.soton.ac.uk/id/eprint/339081
ISSN: 0300-7995
PURE UUID: 92b40199-ea0c-41e7-b186-ef644b23ed28
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 23 May 2012 09:07
Last modified: 18 Mar 2024 02:45

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Contributors

Author: C. Cooper ORCID iD
Author: J-Y. Reginster
Author: B. Cortet
Author: M. Diaz-Curiel
Author: R.S. Lorenc
Author: J.A. Kanis
Author: R. Rizzoli

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