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Minerva Endocrinologica 2007 December;32(4):275-95


language: English, Italian

Evidence based medicine and effective interventions of pharmacological therapy for the prevention of osteoporotic fractures

Cesareo R. 1, Iozzino M. 1, Alva D. 1, Napolitano C. 1, De Rosa B. 1, Contini S. 1, Mallardo L. 2, Lauria A. 2, Reda G. 2, Orsini A. 3

1 Unit of Internal Medicine S. Maria Goretti Public Hospital, Latina, Italy 2 Unit of Endocrinology S. Pertini Public Hospital, Rome, Italy 3 Unit of Surgery Proteus Medica, Latina, Italy


Osteoporosis and fractures associated with it constitute a real and serious socio-medical problem, which only recently has come to the forefront of social consciousness. The authors are carrying out a critical re-examination of the medical literature of osteoporosis pharmacological treatment. Particular attention has been paid to studies which show a clear reduction of the primary endpoint that, in the case of this pathology, consists of a reduction of the fracturing event. According to the examination of the clinical studies introduced, antiresorptive bone agents, such as alendronate and risenderonate, turn out to be molecules with higher levels of evidence implicated on the reduction of the main osteoporotic fractures, in particular the reduction of vertebral and femoral fractures. The 10 years long-term extension studies, in particular those that have seen the employment of alendronate, found a positive outcome regarding densitometry data and a favorable trend in antifracture effectiveness. Ibandronate is another amino-bisphosphonate which was recently validated as an effective drug for the treatment of osteoporosis with its documented ability to meaningfully reduce vertebral fractures. Also ranelate of strontium, a drug that seems to explain its own result in a different way from the other antiriresoptive bone agents, constitutes another valid alternative in the treatment of this pathology. Both of these molecules however, need further studies in order to estimate their antifracture effectiveness in the long term, particularly those related to femoral fractures. Teriparatide and the entire molecule paratohormone are usually not prescribed for its high cost in treatment and because, typically, patients with high-risk level fractures that are already affected, produce more vertebral fractures from moderate to severe intensity.

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