Interní Med. 2015; 17(4): 174-184

Pharmacological treatment of postmenopausal and involution osteoporosis

MUDr.Vít Zikán, Ph.D.

3. interní klinika 1. lékařské fakulty UK a VFN, Praha

Osteoporotic fractures dramatically reduce the quality of life and increase the morbidity and mortality rates following vertebral and proximal

femoral fractures. The goal of osteoporosis treatment is to reduce the risk of fractures and enhance the quality of life in fracture patients.

Pharmacotherapy for osteoporosis should be considered in patients with a significant risk of osteoporotic fractures. To assess the individual

risk of osteoporotic fractures within the following ten years, it is recommended to use the FRAX algorithm that evaluates additional, bonedensity

independent risk factors for fracture (age, previous fractures, fractures in parents, toxic effects, glucocorticoid treatment, rheumatoid

arthritis, and other causes of secondary osteoporosis). When choosing the drug in a particular patient, it is necessary to consider, in addition to

the likelihood of sustaining a fracture and the aetiology of osteoporosis, the mechanism of action of the drug on the bone and other tissues,

its long-term safety, and the patient's willingness to remain on long-term treatment. Antiresorptive (anticatabolic) drugs effectively prevent

bone loss and microarchitectural deterioration; however, they do not promote new bone formation. Osteoanabolic drugs, promoting new

bone formation and increasing bone volume, are useful in patients with severe osteoporosis or in cases where antiresorptive therapy has

failed or in those with low osteoblast activity, e.g. in glucocorticoid-induced osteoporosis. Osteoporosis is a chronic disease and the treatment

is a long-term one. Ensuring good compliance and having patients remain on treatment long term is therefore an essential prerequisite

for successful treatment. Providing adequate calcium and vitamin D intake, regular physical activity, and other measures taken to improve

muscle strength and coordination and reduce the risk of falls are all required for complete efficacy of each drug therapy.

Keywords: postmenopausal osteoporosis, involution osteoporosis, risk factors for fracture, pharmacotherapy

Published: September 19, 2015  Show citation