Abstract
Worldwide, there are millions of people who have been diagnosed with osteoporosis, a bone disease that increases the risk of fracture due to low bone mineral density and deterioration of bone architecture. In the US alone, there are approximately ten million men and women diagnosed with osteoporosis and this number is still growing. Diagnosis is made by measuring bone mineral density. Medications used for the treatment of osteoporosis are bisphosphonates, denosumab, raloxifene, and teriparatide. Recently, romosozumab has been added as well. In recent years, a number of advances have been made in the field of diagnostic methods and the diverse treatment options for osteoporosis. Despite these advances and a growing incidence of osteoporosis, there is a large group being left undertreated or even untreated. This group of the under/untreated has been called the treatment gap. Concerns regarding rare side effects of the medications, such as osteonecrosis of the jaw, have been reported to be one of the many causes for the treatment gap. Also, this group seems not to be sufficiently informed of the major benefits of the treatment and the diversity in treatment options. Knowledge of these could be very helpful in improving compliance and hopefully reducing the gap. In this paper, we summarize recent evidence regarding the efficacy of the various treatment options, potential side effects, and the overall benefit of treatment.
Highlights
The purpose of this review is to summarize the evidence concerning the treatment gap of osteoporosis
With the FRAX, risk factors such as age, race, alcohol use, gender, body mass index, smoking history, prior personal or parental history of fracture, use of glucocorticoids, secondary osteoporosis, rheumatoid arthritis, and femoral neck bone mineral density (BMD) measurements are included to predict the ten-year probability of hip fracture or other major osteoporotic fracture
In phase III clinical trials romosozumab increased BMD at the lumbar spine and total hip by 13.3% and 6.8%, respectively, and reduced the risk of vertebral fracture by 73% compared with a placebo [30]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Osteoporosis is a disease with a high prevalence, which is a major public health burden on our society It is associated with a high incidence of fragility fractures. Often osteoporotic fractures require admission to hospital, hip fractures, which account for 50% of osteoporotic fracture-related hospital admissions [1] Once in hospital, these patients are at a high risk of developing complications, such as thrombosis (27%), urinary tract infections (12–61%), and pneumonia (7%) [1], exacerbating their health problems. One in two women and one in five men who are 50 years of age will have an osteoporotic fracture in their remaining lifetime. Concerns about rare side effects, current comorbidities, and inadequate long-term efficacy of anti-resorptive drugs have led to an increase in the number of untreated patients, referred to as an osteoporosis treatment gap [10]. The diagnosis of osteoporosis is primarily determined by measuring bone mineral density (BMD) using noninvasive dual-energy X-ray absorptiometry
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