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Online ISSN 1827-1707
Javid K. S. 1, Karim M. A. 1, Keenan J. 2, Fekry H. 2, Garlick N. 3, Maruthainar N. 3
1 Department of Arthroplasty Derriford Hospital, Plymouth, UK
2 Department of Orthopedics Derriford Hospital, Plymouth, UK
3 Department of Orthopedic Surgery Royal Free Hospital, London, UK
Osteoporosis is defined as a bone mineral density value that is more than 2.5 SD below the young adult peak. Osteoporosis is a major health threat for millions of people, the biggest concern being risk for fractures, as every year osteoporosis causes two million fractures. Fractures can have profound impact on quality of life, often leading to pain, disability, loss of independence, and even death. They also take a huge economic toll, with fractures costing billions each year. Fortunately, scientists continue to make exiting breakthroughs that are helping to keep bones healthy and prevent debilitating fractures. Clinical studies in nutrition and physical activities have shown to decrease osteoporosis rates. A meta-analysis of clinical trials showed that calcium supplements reduce the risk of vertebral fractures by around 23%. Chapuy et al. looked into the role of combined calcium and vitamin D supplements. They detected a reduction in the risk of hip fractures by 43%. Wagner et al. shown that Alendronate increases vertebral bone mineral density (BMD) by as much as 8% over 3 years. Black et al. showed that Alendronate reduces the risk of hip fracture by around 53%, clinical vertebral fracture by about 45% and wrist fracture by 30%. Harris et al. demonstrated that Risedronate, a biphosphonate, increases vertebral BMD by 5% and hip by 2% to 3% in postmenopausal women with osteoporosis. Chesnut et al. carried out a study on Ibandronate, a biphosphonate, that, taken daily, reduces the risk of new vertebral fractures by 62%. Neer et al. showed that, once-daily injections of parathormone or its amino terminal fragments increase bone formation and bone mass. Treatment with Zoledronic acid over a three year period reduces the risk of vertebral fractures by 70% and risk of hip fracture by 41% and increases BMD by 5% to 6%. Raloxifene, a selective estrogen modulator (SERM), has been shown to decrease vertebral fractures by up to 50% after three years. Finally, genetics can account on up to 75% BMD. Genetics can help researchers develop drugs that could prevent or reverse bone loss that leads to osteoporosis (National Institutes of Health fact sheet). Fleurence et al. demonstrated the cost effectiveness of treating the osteoporosis. Bisphosphonate therapy is most cost effective in populations aged ?70 years and was unlikely to be cost effective in populations aged ≤50 years. There was uncertainty concerning the cost effectiveness of bisphosphonates in such populations aged 60-69 years. In women with low BMD without previous fractures, treatment with alendronate or risedronate appeared to be cost effective in some countries (the UK, the US, Denmark), but there was some uncertainty about the cost effectiveness of etidronate in patients in the highest age groups. Alendronate therapy may be cost effective in women with a T-score of -2.4SD in the US. Screening for low BMD and treatment with alendronate or etidronate appears to be cost effective in postmenopausal women in general and in women with rheumatoid arthritis initiating corticosteroid therapy. Alendronate therapy without screening was also shown to be potentially cost-effective in certain at-risk male populations, as well as in women initiating corticosteroid therapy after the age of 40 years.