Drug Therapy For Osteoporosis Research Articles

Managing osteoporosis in postmenopausal women

To describe strategies used in managing postmenopausal osteoporosis, including a bone-healthy lifestyle, adequate calcium and vitamin D intake, and drug therapy options; considerations in selecting osteoporosis drug therapy; and the role of health-system pharmacists in managing osteoporosis in postmenopausal women. Postmenopausal women are at risk for osteoporosis and fractures. Weight-bearing and resistance exercise, limiting alcohol and caffeine intake, smoking cessation, and fall prevention strategies are part of a bone-healthy lifestyle used to manage postmenopausal osteoporosis. Supplements containing calcium and vitamin D are needed by many postmenopausal women because of an inadequate intake and other factors. The choice of osteoporosis drug therapy should take into consideration patient characteristics and preference and drug efficacy, safety, route of administration, dosing frequency, convenience, cost, and potential for nonadherence. Bisphosphonates generally are preferred for the prevention and treatment of osteoporosis in postmenopausal women, with raloxifene, teriparatide, and calcitonin salmon as alternatives. Denosumab, a fully human monoclonal immunoglobulin G(2) antibody, may become available soon for prevention and treatment of postmenopausal osteoporosis. Health-system pharmacists can improve the management of osteoporosis in postmenopausal women by counseling them on a bone-healthy lifestyle and making recommendations for calcium and vitamin D supplements and osteoporosis medications to prevent or treat the disease. A variety of approaches are available to promote bone health in postmenopausal women. Health-system pharmacists can promote interventions to optimize patient outcomes.

Teriparatide May Accelerate Healing in Delayed Unions of Type III Odontoid Fractures

Case Report. To report on the treatment of 3 cases of painful delayed unions of type III odontoid fractures with teriparatide. Fractures of the C2 vertebra, also known as odontoid fractures, are an important subset of cervical spine fractures. Type III odontoid fractures pass through predominately cancellous bone of C2. Generally accepted treatment is external immobilization with either a rigid collar or a halo vest for 8 to 12 weeks. We report 3 patients who, despite external immobilization, developed painful delayed unions of type III odontoid fractures. Teriparatide is a novel anabolic drug therapy for osteoporosis. It has been shown to stimulate osteoblasts, enhance bone connectivity, increase endosteal cortical thickness, and improve bone mineral content. The drug is given through subcutaneous injection of 20 microg/d for between 6 weeks and 2 years. We treated these 3 patients with teriparatide. Each was informed that details of their case would be submitted for publication. Retrospective case analysis. All 3 patients experienced both rapid clinical improvement and computed tomography evidence of fracture union. These 3 cases represent relatively uncommon clinical scenarios in which type III odontoid fractures in osteoporotic women failed to unite with external immobilization over several months. The patients presented for follow-up with substantial, activity-limiting neck pain. All 3 were begun on teriparatide doses therapeutic for osteoporosis, and all 3 experienced both remarkable resolution of chronic neck pain and computed tomography-confirmed union of the fractures.

OSTEOPOROSIS AND C-REACTIVE PROTEIN

A chronic inflammatory process is one of the risk factors of secondary osteoporosis (OP) and its related fractures. Determination of the level of C-reactive protein (CRP) is used to estimate the magnitude of an inflammatory reaction. The developed highly sensitive (hs) methods make it possible to reveal the so-called subclinical level of inflammation and to assess its role in the development of various diseases. Objective: To reveal an association between the level of hs CRP and the development of OP. Subjects and methods. The database of the study «Cardiovascular diseases and osteoporosis» performed at the Research Institute of Rheumatology, Russian Academy of Medical Sciences, was used. The study enrolled 79 women, of them 64 were postmenopausal and 15 had a preserved menstrual cycle. Their mean age was 60 and 48 years, respectively. The exclusion criteria were systemic rheumatic diseases and conditions, which are risk factors for OP, and drug therapy for OP. Bone mineral density (BMD), biochemical blood analysis, bone metabolism markers, and CPR levels were determined by the hs method. Results. In the postmenopause group, the mean value of hs CRP was 1.16 mg/l; the values of hs-CRP were in the range of 3-10 mg/l in 17% cases, which is associated with subclinical inflammation. Those of CRP were lower than 3 mg/l in 80% of cases. In 87% of the women with a preserved cycle, the level of CRP was in the normal range and averaged 2.25 mg/l. There was a positive correlation of hs CRP only with the level of bone alkaline phosphatase (r = 0.26; p = 0.04) in the menopause group and with BMD in the femoral neck (r = 0.65; p = 0.009) in the preserved cycle group. There were no significant differences in the level of hs-CRP between the OP subjects and the normal values of BMD in the menopausal women. No analysis was made in the preserved cycle subgroup due to a small number of cases. Conclusion. There was no strong evidence that there was an association between hs CRP (the values were in the normal range and corresponded to those of subclinical inflammation) and osteoporosis.

Hip fracture incidence in Japan: estimates of new patients in 2007 and 20-year trends

SummaryWe estimated the number of hip fracture patients in 2007 in Japan and investigated the trends in incidence during a 20-year period from 1987 to 2007. Despite the increasing number of new patients, the incidence of hip fracture in some age groups showed the possibility of decline.PurposeThe aims of this study were to estimate the number of hip fracture patients in 2007, to investigate the trends in incidence during a 20-year period from 1987 to 2007, and to show the regional differences in Japan.MethodsData were collected through a nationwide survey based on hospitals by the mailing method. Hip fracture incidences by sex and age and standardized incidence ratios by region were calculated.ResultsThe estimated numbers of new hip fracture patients in 2007 were 148,100 in total (95% CI, 144,000–152,200), 31,300 (30,500–32,100) for men, and 116,800 (113,900–119,700) for women. The incidence rate in men aged 60–69 years and that in women aged 60–79 years were the lowest in the 15-year period from 1992 to 2007. The incidence was higher in western areas of Japan than in eastern areas in both men and women.ConclusionsDespite the increasing number of new patients, the incidence of hip fracture in some age groups for both men and women showed the possibility of decline. The exact reasons for this are unknown, but drug therapy for osteoporosis and fall prevention programs might have influenced the results. Some nutrient intakes might explain the regional differences not only in Japan but also in some other countries.

Future therapeutic targets in osteoporosis

To describe new agents for the treatment of osteoporosis, discuss a conceptual framework of agents that are antiresorptive or anabolic, and review pathways that affect bone turnover and steps in those pathways that are targets for new therapeutic agents. Novel antiresorptive agents are being developed. Denosumab, a fully human mononoclonal antibody to receptor activator of nuclear factor kappa B ligand, has completed its major fracture trial. Assessment of odanacatib, an inhibitor of cathepsin K, an osteoclast enzyme required for resorption of bone matrix, is underway. Glucagon-like peptide 2 is an intestinal peptide that prevents the nocturnal rise in bone resorption. Anabolic agents act by stimulating new bone formation. Novel anabolic agents in development include antibodies that target molecules (sclerostin and Dkk1) involved in Wnt signaling, a pathway that regulates gene transcription of proteins that are important for osteoblast function. An antagonist to the calcium-sensing receptor and an activin receptor fusion protein, which functions as an activin antagonist, have shown promise as anabolic agents in early human trials. This review discusses potential future advances in drug therapy for osteoporosis including novel antiresorptive and anabolic agents that may become available in the coming years.

Bone Modifiers and the Quest to Slow Progression of Aortic Stenosis††The views expressed in this editorial are solely those of the author and do not represent the opinions of the Uniformed Services of the Health Sciences or the United States Department of Defense.

Aortic stenosis (AS) will likely become increasingly frequent with the aging of the American population. The difficulties in treating elderly patients with critical AS emphasize the potential value of a strategy to slow the advancement of aortic valve calcification. Recent prospective trials of statins and angiotensin-converting enzyme inhibitors have been disappointing. New options are needed to achieve a truly effective strategy for retarding the advancement of AS. In this context, the observations of Skolnick et al appearing in this issue of The American Journal of Cardiology are particularly intriguing. In a retrospective review of patients followed for mild or moderate AS, these investigators found that 18 patients receiving treatment for osteoporosis had significantly less decrement in aortic valve area on follow-up echocardiography than 37 not receiving such treatment. The most attractive explanation is an action of drug therapy for osteoporosis, most often bisphosphonates, to retard aortic valve calcification. The mechanism for this action is not clear, although numerous possibilities can be postulated on the basis of the multiple complex processes controlling tissue calcification. In conclusion, the investigators' findings deserve further study to clarify drug impact on aortic valve calcification as well as confirm the clinical findings in a larger and more diverse population. Such investigation should also assess the role of vitamin D and calcium supplementation, common features of treatment for osteoporosis. Currently available results are too preliminary to justify the use of bisphosphonates or other osteoporosis therapies to slow the progression of AS.

Diagnosis and management of osteoporosis in the older senior.

The older senior is at high risk for osteoporosis. It is important for healthcare providers to be fully aware of the potential risks and benefits of diagnosing and treating osteoporosis in the older senior population. Data indicate that bone mineral density testing is under-utilized and drug therapy is often not initiated when indicated in this population. Bone mineral density testing with central dual energy x-ray absorptiometry is essential and cost-effective in this population. All older seniors should be educated on a bone-healthy lifestyle including age-appropriate weight-bearing exercise and smoking cessation if necessary. It is important to remember that falls play a very important role in the risk for osteoporotic fractures, especially in the older senior. All older seniors should be evaluated annually for falls and strategies should be implemented to reduce fall risk in this population. The risk for vitamin D insufficiency and deficiency is high in the older senior and can contribute to falls and fractures. Adequate intakes of calcium and vitamin D are important and deficiencies need to be treated. Data on osteoporosis drug therapy in the older senior are lacking. Based on data from subgroup analyses of large osteoporosis trials in postmenopausal women, current osteoporosis therapies appear safe and efficacious in the older senior and most will live long enough to derive a benefit from these therapies. Further studies are needed in older seniors, especially men, to better understand the risks and benefits of pharmacologic therapy for the management of osteoporosis.

Clinical challenges in the management of osteoporosis

While knowledge regarding the diagnosis and treatment of osteoporosis has expanded dramatically over the last few years, gaps in knowledge still exist with guidance lacking on the appropriate management of several common clinical scenarios. This article uses fictional clinical scenarios to help answer three challenging questions commonly encountered in clinical practice. The first clinical challenge is when to initiate drug therapy in a patient with low bone density. It is estimated that 34 million America have low bone density and are at a higher risk for low trauma fractures. Limitations of using bone mineral density alone for drug therapy decisions, absolute risk assessment and evidence for the cost-effectiveness of therapy in this population are presented. The second clinical challenge is the prevention and treatment of vitamin D deficiency. Appropriate definitions for vitamin D insufficiency and deficiency, the populations at risk for low vitamin, potential consequences of low vitamin D, and how to manage a patient with low vitamin D are reviewed. The third clinical challenge is how to manage a patient receiving drug therapy for osteoporosis who has been deemed a potential treatment failure. How to define treatment failure, common causes of treatment failure, and the approach to the management of a patient who is not responding to appropriate osteoporosis therapy are discussed.

Fall prevention in older adults: towards an integrated population-based perspective

Two articles in the 19 January 2008 BMJ 12 highlight tension between the clinical and public health approaches to fracture prevention among older adults. Jarvinen et al 1 review drug...

Drug Therapy for Osteoporosis

Drug Therapy for Osteoporosis

3-year results of a member and physician intervention to reduce risk associated with glucocorticoid-induced osteoporosis in a health plan.

Accelerated bone loss is a well-known outcome of chronic treatment with glucocorticoids, making glucocorticoid-induced osteoporosis a significant cause of morbidity and a burden on health care resources. Recommendations for prevention and treatment of glucocorticoid-induced osteoporosis include therapy with a bisphosphonate or calcitonin for patients taking a prednisone equivalent of 5 mg per day or more for 3 months or more. To evaluate the effects of a targeted member and physician educational intervention on the use of anti-osteoporotic drug therapy in patients using chronic oral glucocorticoid therapy. Pharmacy claims were analyzed for a 4-month period in each of 3 years, for claims with dates of service from April 1 through July 30, 2003, May 1 through August 31, 2004, and February 4 through May 5, 2005, to identify all adult members of a health plan of approximately 1.3 million members who received an oral glucocorticoid (e.g., prednisone, dexamethasone) for at least 90 of 120 days (chronic use) and did not receive a medication for osteoporosis prevention (e.g., risedronate, ibandronate, etidronate, raloxifene, alendronate, calcitonin) during the same 120-day time period. The intervention involved direct-to-patient mailing of a cover letter and a 2-page educational brochure, and a physician mailing that included the same 2-page educational brochure, a 1-page table of recommended drug therapies for prevention of osteroporosis, and an invitation for physicians to request by fax-back a list of at-risk patients. Follow-up claims analyses were conducted for 120 days after each of the 3 intervention periods to determine the number and percentage of target patients who were initiated and maintained on a medication to prevent osteoporosis. The prevalence of health plan members at risk of glucocorticoidinduced osteoporosis was 0.28% in 2003, 0.29% in 2004, 0.29% in 2005, and 0.29% during the 3 years combined. Approximately 47.5% of patients (n = 5,140) during the 3-year period who received chronic glucocorticoids also received drug therapy for prevention or treatment of osteoporosis. Women made up 59.6% (6,450/10,822) of patients who received chronic glucocorticoid therapy during the 3 years; 50.9% (3,285/6,450) of the female patients, and 54.8% (2,397/4,372) of the male patients on chronic glucocorticoid therapy were at risk because of the absence of preventive therapy with an anti-osteoporosis medication. During the 3 years, 404 (7.1%) of the total 5,682 male and female patients at risk because of chronic glucocorticoid therapy and who were the subjects of the educational intervention were started on an osteoporosis medication following the mailings. Of these, 84.9% (343/404) continued on both the glucocorticoid therapy and an anti-osteoporosis medication in the subsequent 4-month follow-up period. During the 3 years, only 4.9% of targeted physicians (n = 196), affecting 6.8% of at-risk patients (n=387), requested a list of their patients at risk via the fax-back opportunity. A simple intervention program that screened at-risk patients and reached out to these patients and their physicians via a target-mailing intended to reduce the risk of glucorticoid-induced osteoporosis was associated with a modest increase in the proportion of at-risk patients receiving preventive drug therapy for osteoporosis.

Systematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis

To quantify the adherence of patients to drug therapy for osteoporosis in real-world settings via a systematic review and meta-analysis of observational studies. The PubMed and Cochrane databases were searched for English-language observational studies published from January 1, 1990, to February 15, 2006, that assessed patient adherence to drug therapy for osteoporosis using the following medical subject headings and keywords: drug therapy, medication adherence, medication persistence, medication possession ratio, patient compliance, and osteoporosis. Studies were stratified into 3 groups: persistence (how long a patient continues therapy), compliance (how correctly, in terms of dose and frequency, a patient takes the medication), and adherence (a combination of persistence and compliance). A random-effects model was used to pool results from the selected studies. Twenty-four studies were included in the meta-analysis. The pooled database-derived persistence rate was 52% (95% confidence interval [CI], 44%-59%) for treatment lasting 1 to 6 months, 50% (95% CI, 37%-63%) for treatment lasting 7 to 12 months, 42% (95% CI, 20%-68%) for treatment lasting 13 to 24 months, returning to 52% (95% CI, 45%-58%) for treatment lasting more than 24 months. Pooled adherence rates decreased from 53% (95% CI, 52%-54%) for treatment lasting 1 to 6 months to 43% for treatment lasting 7 to 12 months (95% CI, 38%-49%) or 13 to 24 months (43%; 95% CI, 32%-54%). The pooled refill compliance estimate was 68% (95% CI, 63%-72%) for treatment lasting 7 to 12 months and 68% (95% CI, 67%-69%) for treatment lasting 13 to 24 months. The pooled self-reported compliance rate was 62% (95% CI, 48%-75%) for treatment lasting 1 to 6 months and 66% (95% CI, 45%-81%) for treatment lasting 7 to 12 months. One-third to half of patients do not take their medication as directed. Nonadherence occurs shortly after treatment initiation. Terms and definitions need to be standardized to permit comparability of technologies designed to improve patient adherence. Prospective trials are needed to assess the relationship between adherence and patient outcomes.

Systematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis

Systematic Review and Meta-analysis of Real-World Adherence to Drug Therapy for Osteoporosis

Fracture incidence and changes in quality of life in women with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO)

In this observational study of women with an inadequate clinical outcome to osteoporosis therapy, those with a fracture at baseline were more likely to sustain an incident fracture and have a worse health-related quality of life than those without prior fracture. The Observational Study of Severe Osteoporosis (OSSO) was designed to assess the fracture incidence and health-related quality of life (HRQoL) in women with an inadequate clinical outcome to osteoporosis therapy. Post-menopausal women (N=1,885) with established osteoporosis and an inadequate clinical response to osteoporosis drug therapy defined as: a) a fragility fracture despite therapy for one year (index fracture, N=988), or b) discontinued drug therapy due to adverse effects and/or non-compliance (N=897), were assessed during one year for HRQoL using the EQ-5D and the QUALEFFO questionnaires. One hundred and sixty-six (8.8%) women had a total of 209 incident fractures (1,139 fractures/10,000 women-years). Women with an index fracture were more likely to sustain an incident fracture than those without prior fractures (hazard ratio 1.91; 95% CI: 1.37-2.66; p<0.001). Co-morbidities or antidepressant use at baseline also increased the risk of incident fracture. Median total EQ-5D Health State Values and QUALEFFO scores were worse in women with an incident fracture regardless of index fracture status. The worst scores were reported in the EQ-5D sub-domains of self-care, usual activities and pain/discomfort. Women with an inadequate response to osteoporosis therapy had a high rate of incident fracture which had an adverse impact on HRQoL.

Compliance with osteoporosis drug therapy and risk of fracture

Patient compliance with osteoporosis drug therapy is often poor in clinical practice and may be associated with higher risk of fracture. A nested case-control study was undertaken using a US health insurance claims database. The source population included all women aged >or=45 years who began drug therapy for osteoporosis. Cases consisted of those who experienced an osteoporosis-related fracture; they were matched to controls without osteoporosis-related fracture. Compliance with osteoporosis drug treatment was assessed in terms of the number of therapy-days received and medication possession ratio (MPR). Conditional logistic regression was employed to examine the relationship between compliance and fracture risk. A total of 453 women with osteoporosis-related fracture were identified and matched to 2,160 controls. Fracture risk was significantly lower for patients with >180 days of therapy [181-360 days: odds ratio (OR) = 0.70, 95% CI = 0.49-0.99; >360 days: OR = 0.65, 95% CI = 0.43-0.99) versus those with <or=30 days. Risk was also lower for patients with MPR >or=90% (OR = 0.70, 95% CI = 0.52-0.93) versus those with MPR <30%. Fracture risk decreased as compliance increased (p(trend) < 0.05). Among women initiating drug therapy for osteoporosis, better compliance is associated with reduced risk of fracture.

Characterization of patients with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO)

Osteoporotic fractures remain a major public health problem. Currently available osteoporosis therapies significantly reduce the risk of fractures, but up to 50% of patients have an inadequate clinical outcome to therapy. To describe the clinical and quality of life (QOL) of a study population meeting a proposed definition of inadequate clinical outcome to osteoporosis therapy, recruited for the Observational Study of Severe Osteoporosis (OSSO). Cross-sectional, observational study. Post-menopausal women with osteoporosis (n = 2314) were divided into Group 1 (those who had previously experienced a fragility fracture despite osteoporosis drug therapy for at least 12 months) (n = 1309, 57%), or Group 2 (those who had previously discontinued osteoporosis drug therapy due to non-compliance or side-effects) (n = 1005; 43%). Baseline clinical characteristics, quality of life (QOL) and osteoporosis/falls risk factors were analysed. The overall population had low BMD (mean +/- SD T-score at lumbar spine -3.1 +/- 1.1), and risk factors for fracture such as previous fractures (67.8%), family history (15.1%), and prolonged glucocorticoid use (17.5%). QOL was poor: total QUALEFFO and EQ-5D scores were 46.8 +/- 18.7, and 0.50 +/- 0.33, respectively. Patients in Group 1 had higher age and body mass index, fewer hours of exercise, more previous fragility fractures and falls, and poorer QOL scores. Our definition of inadequate clinical outcome from osteoporosis drug therapy identifies a severe osteoporosis cohort with poor QOL and increased fracture risk. Using such a definition may lead to earlier recognition of inadequate clinical outcome to osteoporosis therapy, and improved interventions and results.

Compliance with drug therapy for postmenopausal osteoporosis

Patient compliance with pharmacotherapy for osteoporosis is typically poor in clinical practice; less frequent dosing with bisphosphonates may improve compliance. Using data from 49 US health plans, we identified all women aged >/=45 years with osteoporosis who initiated therapy with a bisphosphonate, calcitonin, estrogen, or raloxifene. Compliance was examined alternatively in terms of incidence of adherence failure (medication days <80% of possible) and persistence failure (gap in therapy >/=90 days), and was compared across treatment groups using Kaplan-Meier methods and Cox proportional hazards models. The study population included 18,822 women, 48% of whom initiated weekly bisphosphonate therapy. Overall risk of adherence failure was 47% at 3 months, 70% at 1 year, and 84% at 3 years. Risk of persistence failure was 47% at 1 year, and 77% at 3 years. In multivariate analyses, risk of adherence failure was higher for calcitonin (hazard ratio=2.7 vs weekly bisphosphonate therapy, p<0.01), but comparable for all other therapies. Relative risks of persistence failure were generally similar. Approximately three-quarters of women who initiate osteoporosis drug therapy are non-adherent with treatment within 12 months, and almost 50% have discontinued such therapy by this time. Compliance with weekly bisphosphonate therapy is generally no better than that with osteoporosis medications requiring more frequent dosing.

Prescription drug therapies for prevention and treatment of postmenopausal osteoporosis.

To characterize the changes in bone mass with age in women and men, explain the physiology and pathophysiology of the bone remodeling process, identify the targets for prescription osteoporosis drugs in this process, and provide details about the uses, efficacy, safety, and economics of prescription drug therapies for osteoporosis prevention and treatment. Preventing accelerated bone loss and decreasing age-related decreases in bone density are the primary goals of prescription drug therapy for osteoporosis. Bisphosphonates are the drugs of choice for preventing and treating postmenopausal osteoporosis. Alternatives for patients who cannot take bisphosphonates include raloxifene and calcitonin salmon. Menopause is accompanied by a rapid loss in bone mass that is followed by annual losses due to aging in women, which are similar to age-related bone mass decreases in men. Most prescription drug therapies for osteoporosis prevention or treatment reduce bone resorption by inhibiting osteoclast activation and activity, with only one medication class able to increase bone formation by stimulating osteoblasts. Denosumab, an investigational monoclonal antibody that inhibits nuclear factor kB ligand, would be a new class of anti-resorptive medications. Bisphosphonates currently are the drugs of choice for preventing and treating osteoporosis, with 7- and 10-year safety data available for risedronate and alendronate, respectively. Weekly and monthly regimens of bisphosphonates improve patient acceptance. Recently, an injectable form of ibandronate received U.S. Food and Drug Administration approval for once every 3 months administration. Raloxifene and calcitonin salmon are alternatives for patients who cannot take bisphosphonates because of contraindications or adverse effects. Teriparatide, a recombinant parathyroid hormone fragment, not only increases bone mineral density but also increases bone connectivity. Osteoporosis medications are usually safe, especially if used correctly with proper patient education. Treating osteopenia has not been found to be cost effective in women. However, obtaining a dual-energy X-ray absorptiometry scan and treating osteoporosis has resulted in cost savings in senior women living in community and nursing home residences. Pharmacists have multiple opportunities for preventing and treating osteoporosis.

Die Ballonkyphoplastie in der Behandlung des Rückenschmerzes

Experience of just under 5 years has shown that balloon kyphoplasty can be just as successfully employed as the longer-stablished vertebroplasty for the treatment of back pain due to recent or prior osteoporotic fractures as well as new traumatic fractures. Among 345 patients with a total of 690 treated vertebral bodies, the change in pain symptomatology was analyzed for a follow-up period of 12 months in 40 study patients who underwent kyphoplasty and a control group of 20 patients. In addition, the pain experienced by a further 29 patients with new traumatic vertebral body fractures was monitored over a 12-month period. These fractures were partly managed by fixateur interne alone and by a combination of fixateur interne and kyphoplasty. The 40 patients treated by kyphoplasty had a baseline VAS score of 26.2+/-2.00, which increased to 44.4+/-3.11 after 12 months, while the respective scores for the control group were 33.6+/-4.21 and 34.3+/-4.35. In the 29 patients with new traumatic vertebral body fractures, the initial VAS score was 62 and after 12 months a distinct reduction of pain was noted with a score of 20 (100 = maximum pain, 0 = no pain). The number of times that the 40 patients managed by kyphoplasty had to consult their general practitioner was significantly reduced by the pain therapy. Balloon kyphoplasty verifiably improved the pain symptomatology after vertebral fracture over a period of 12 months. Comparison with the control group, which received the same osteoporosis drug therapy, confirmed the effect of this minimally invasive treatment form.

Strategies for the prevention and control of osteoporosis in developing countries

The frequency of osteoporosis and fragility fractures has been studied to a very limited extent in few developing countries. The aim of this paper is to review briefly the burden of osteoporosis and fragility fractures in these countries and to propose some strategies for the prevention and control of those conditions, considering barriers and facilitators for their implementation. The evolution of the demographic composition in most regions with developing countries shows a considerable increase in life expectancy and therefore, a significant growth in elderly population can be expected. Reports on the incidence of fragility fractures show figures in many of those countries that are comparable to those found in developed nations. Health resources (for acute treatment of fractures, their rehabilitation and chronic management, for diagnostic centers and drug therapy for osteoporosis) are limited in most of those regions and are allocated to other health priorities. Internationally accepted guidelines can be adapted to the realities of developing nations and may be promoted by organizations of health professionals and patients, but require endorsement and support by health authorities. The steps should include: (a) campaigns to increase awareness, both among the population at risk and relevant health workers; (b) the promotion of a preventive lifestyle in the general population; (c) the development of national or regional, evidence-based guidelines for the diagnosis and treatment of osteoporosis; (d) development and implementation of guidelines for the treatment of fragility fractures, their rehabilitation and prevention of falls; (e) collection of economic data on fractures and osteoporosis; and (f) development of country-specific fracture databases. These steps may help in reducing the increasing burden of osteoporotic fractures. Their implementation will require solid scientific basis and commitment from policy makers, health professionals, patient organizations, and ultimately the general population.