An overview on the treatment of postmenopausal osteoporosis

FapUNIFESP (SciELO) - Tập 58 Số 2 - Trang 162-171 - 2014
Sérgio Setsuo Maeda1, Marise Lazaretti‐Castro2
1Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brazil
2Universidade Federal de São Paulo, Brazil

Tóm tắt

Osteoporosis is a worldwide health problem related to the aging of the population, and it is often underdiagnosed and undertreated. It is related to substantial morbidity, mortality and impairment of the quality of life. Estrogen deficiency is the major contributing factor to bone loss after menopause. The lifetime fracture risk at 50 years of age is about 50% in women. The aim of the treatment of osteoporosis is to prevent fractures. Non-pharmacological treatment involves a healthy diet, prevention of falls, and physical exercise programs. Pharmacological treatment includes calcium, vitamin D, and active medication for bone tissue such, as anti-resorptives (i.e., SERMs, hormonal replacement therapy, bisphosphonates, denosumab), bone formers (teriparatide), and mixed agents (strontium ranelate). Bisphosphonates (alendronate, risedronate, ibandronate, and zoledronate) are the most used anti-resorptive agents for the treatment of osteoporosis. Poor compliance, drug intolerance, and adverse effects can limit the benefits of the treatment. Based on the knowledge on bone cells signaling, novel drugs were developed and are being assessed in clinical trials.

Từ khóa


Tài liệu tham khảo

2006, Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society, Menopause, 13, 340, 10.1097/01.gme.0000222475.93345.b3

Kanis JA, 1994, Assessment of fracture risk and its applications to screening for postmenopausal osteoporosis: synopsis of a WHO report, Osteoporosis Int, 4, 368, 10.1007/BF01622200

Pinheiro MM, 2010, Epidemiology of osteoporotic fractures in Brazil: what we have and what we need, Arq Bras Endocrinol Metab, 54, 164, 10.1590/S0004-27302010000200012

Kowalski SC, 2004, Resource utilization in postmenopausal osteoporosis without incident fractures, J Reumathol, 31, 938

Araujo DV, 2005, Cost of osteoporotic hip fractures in the Brazilian private health care system, Arq Bras Endocrinol Metab, 49, 897

Fortes EM, 2008, High morbid-mortability and reduced level of osteoporosis diagnosis among elderly people who had hip fractures in São Paulo City, Arq Bras Endocrinol Metabol, 52, 1106

Daroszewska A, 2012, Prevention and treatment of osteoporosis in women: an update, Obstet Gynaecol Reprod Med, 22, 162, 10.1016/j.ogrm.2012.02.007

Lirani-Galvão APR, 2010, Physical approach for prevention and treatment of osteoporosis, Arq Bras Endocrinol Metab, 54, 171, 10.1590/S0004-27302010000200013

2011

Pinheiro MM, 2009, Nutrient intakes related to osteoporotic fractures in men and women -- the Brazilian Osteoporosis Study (BRAZOS), Nutr J, 8

Pinto AM, 2002, Consenso brasileiro de osteoporose 2002, Rev. Bras. Reumatol, 42, 343

Bolland MJ, 2010, Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis, BMJ, 341, 10.1136/bmj.c3691

Wang L, 2012, Calcium intake and risk of cardiovascular disease: a review of prospective studies and randomized clinical trials, Am J Cardiovasc Drugs, 12, 105, 10.2165/11595400-000000000-00000

Bockman RS, 2012, Commentary on calcium supplements and cardiovascular events, J Clin Densitom, 15, 130, 10.1016/j.jocd.2011.10.002

Holick MF, 2011, Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline, J Clin Endocrinol Metab, 96, 1911, 10.1210/jc.2011-0385

Dawson-Hughes B, 2005, Estimates of optimal vitamin D status, Osteoporos Int, 16, 713, 10.1007/s00198-005-1867-7

Arantes HP, 2013, Correlation between 25-hydroxyvitamin D levels and latitude in Brazilian postmenopausal women: from the Arzoxifene Generations Trial, Osteoporos Int, 24, 2707, 10.1007/s00198-013-2366-x

Maeda SS, 2013, Factors affecting vitamin D status in different populations in the city of Sao Paulo, Brazil: the Sao PAulo vitamin D Evaluation Study (SPADES), BMC Endocr Disord, 13, 10.1186/1472-6823-13-14

Khosla S, 2010, Update on estrogens and the skeleton, J Clin Endocrinol Metab, 95, 3569, 10.1210/jc.2010-0856

Wells G, 2002, Meta-analyses of therapies for postmenopausal osteoporosis. V. Meta-analysis of the efficacy of hormone replacement therapy in treating and preventing osteoporosis in postmenopausal women, Endocr Rev, 23, 529, 10.1210/er.2001-5002

Anderson GL, 2004, Women?s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women?s Health Initiative randomized controlled trial, JAMA, 291, 1701, 10.1001/jama.291.14.1701

Johnell O, 2002, Additive effects of raloxifene and alendronate on bone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis, J Clin Endocrinol Metab, 87, 985, 10.1210/jcem.87.3.8325

Sambrook PN, 2004, Alendronate produces greater effects than raloxifene on bone density and bone turnover in postmenopausal women with low bone density: results of EFFECT (Efficacy of FOSAMAX versus EVISTA Comparison Trial) International, J Intern Med, 255, 503, 10.1111/j.1365-2796.2004.01317.x

Ettinger B, 1999, Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators, JAMA, 282, 637, 10.1001/jama.282.7.637

Siris ES, 2005, Continuing Outcomes Relevant to Evista (CORE) Investigators. Skeletal effects of raloxifene after 8 years: results from the continuing outcomes relevant to Evista (CORE) study, J Bone Miner Res, 20, 1514, 10.1359/JBMR.050509

Vogel VG, 2006, Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial, JAMA, 295, 2727, 10.1001/jama.295.23.joc60074

Barrett-Connor E, 2006, Raloxifene Use for The Heart (RUTH) Trial Investigators. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women, N Engl J Med, 355, 125, 10.1056/NEJMoa062462

Cummings SR, 2010, PEARL Study Investigators. Lasofoxifene in postmenopausal women with osteoporosis, N Engl J Med, 362, 686, 10.1056/NEJMoa0808692

Silverman SL, 2012, Bazedoxifene Study Group. Sustained efficacy and safety of bazedoxifene in preventing fractures in postmenopausal women with osteoporosis: results of a 5-year, randomized, placebo-controlled study, Osteoporos Int, 23, 351, 10.1007/s00198-011-1691-1

Watts NB, 2010, Long-term use of bisphosphonates in osteoporosis, J Clin Endocrinol Metab, 95, 1555, 10.1210/jc.2009-1947

Fleisch H, 1998, Bisphosphonates: mechanisms of action, Endocr Rev, 19, 80, 10.1210/edrv.19.1.0325

Boivin GY, 2000, Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women, Bone, 27, 687, 10.1016/S8756-3282(00)00376-8

Schnitzer T, 2000, Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis, Alendronate Once-Weekly Study Group. Aging, 12, 1

Black DM, 1996, Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group, Lancet, 348, 1535, 10.1016/S0140-6736(96)07088-2

Cummings SR, 1998, Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial, JAMA, 280, 2077, 10.1001/jama.280.24.2077

Pols HA, 1999, Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax International Trial Study Group, Osteoporos Int, 9, 461, 10.1007/PL00004171

Black DM, 2006, Cummings SR; FLEX Research Group. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial, JAMA, 296, 2927, 10.1001/jama.296.24.2927

Reginster J, 2000, Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group, Osteoporos Int, 11, 83, 10.1007/s001980050010

McClung MR, 2001, Hip Intervention Program Study Group. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group, N Engl J Med, 344, 333, 10.1056/NEJM200102013440503

Chesnut CH, 2004, Oral Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe (BONE). Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis, J Bone Miner Res, 19, 1241, 10.1359/JBMR.040325

Miller PD, 2005, Monthly oral ibandronate therapy in postmenopausal osteoporosis: 1-year results from the MOBILE study, J Bone Miner Res, 20, 1315, 10.1359/JBMR.050313

Delmas PD, 2006, Intravenous ibandronate injections in postmenopausal women with osteoporosis: one-year results from the dosing intravenous administration study, Arthritis Rheum, 54, 1838, 10.1002/art.21918

Black DM, 2007, HORIZON Pivotal Fracture Trial. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis, N Engl J Med, 356, 1809, 10.1056/NEJMoa067312

Lyles KW, 2007, for the HORIZON Recurrent Fracture Trial. Zoledronic Acid in Reducing Clinical Fracture and Mortality after Hip Fracture, NEJM, 357, 10.1056/NEJMoa074941

Black DM, 2012, The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT), J Bone Miner Res, 27, 243, 10.1002/jbmr.1494

Boonen S, 2012, Postmenopausal osteoporosis treatment with antiresorptives: effects of discontinuation or long-term continuation on bone turnover and fracture risk--a perspective, J Bone Miner Res, 27, 963, 10.1002/jbmr.1570

Rizzoli R, 2011, Adverse reactions and drug-drug interactions in the management of women with postmenopausal osteoporosis, Calcif Tissue Int, 89, 91, 10.1007/s00223-011-9499-8

Hellstein JW, 2011, American Dental Association Council on Scientific Affairs Expert Panel on Antiresorptive Agents. Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs, J Am Dent Assoc, 142, 1243

Chesnut CH, 2000, A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group, Am J Med, 109, 267, 10.1016/S0002-9343(00)00490-3

Cummings SR, 2009, FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis, N Engl J Med, 361, 756, 10.1056/NEJMoa0809493

Bone HG, 2013, The effect of three or six years of denosumab exposure in women with postmenopausal osteoporosis: results from the FREEDOM extension, J Clin Endocrinol Metab, 98, 4483, 10.1210/jc.2013-1597

Bone HG, 2011, Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass, J Clin Endocrinol Metab, 96, 972, 10.1210/jc.2010-1502

Neer RM, 2001, Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis, N Engl J Med, 344, 1434, 10.1056/NEJM200105103441904

Black DM, 2003, PaTH Study Investigators. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis, N Engl J Med, 349, 1207, 10.1056/NEJMoa031975

Meunier PJ, 2004, The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis, N Engl J Med, 350, 459, 10.1056/NEJMoa022436

Reginster JY, 2005, Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study, J Clin Endocrinol Metab, 90, 2816, 10.1210/jc.2004-1774

Reginster JY, 2012, Maintenance of antifracture efficacy over 10 years with strontium ranelate in postmenopausal osteoporosis, Osteoporos Int, 23, 1115, 10.1007/s00198-011-1847-z

Nielsen SP, 1999, Influence of strontium on bone mineral density and bone mineral content measurements by dual X-ray absorptiometry, J Clin Densitom, 2, 371, 10.1016/S1094-6950(06)60402-2

Langdahl B, 2012, Odanacatib in the treatment of postmenopausal women with low bone mineral density: five years of continued therapy in a phase 2 study, J Bone Miner Res, 27, 2251, 10.1002/jbmr.1695