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Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 6. Use of bisphosphonates in the treatment of osteoporosis.
CMAJ. 1996 Oct 01; 155(7):945-8.CMAJ

Abstract

OBJECTIVE

To describe the mechanisms of action of bisphosphonates in the treatment of osteoporosis and compare bisphosphonate therapy with other treatments.

OPTIONS

The bisphosphonates, etidronate, alendronate, clodronate, pamidronate, tiludronate, ibandronate and risedronate; combined bisphosphonates and estrogen; combined bisphosphonates and calcium supplements.

OUTCOMES

Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with bisphosphonate treatment.

EVIDENCE

Relevant clinical studies and reports were examined with emphasis on recent controlled trials. The availability of treatment products in Canada was also considered.

VALUES

Reducing fractures, increasing bone mineral density and minimizing side effects of treatment were given a high value.

BENEFITS, HARMS AND COSTS

Treatment with bisphosphonates may be an acceptable alternative to ovarian hormone therapy in increasing bone mass and decreasing fractures associated with osteoporosis. Compared with estrogens, bisphosphonates are bone-tissue specific, have equal or greater antiresorptive effect and have few side effects and no known risk for carcinogenesis. They also hold promise in treating male osteoporosis and steroid-induced bone loss. Prolonged, continuous treatment with etidronate may lead to impaired calcification of newly formed bone; therefore, etidronate is administered cyclically. This risk is not present in newer generations of bisphosphonates.

RECOMMENDATIONS

Bisphosphonate therapies may be considered as an alternative to ovarian hormone therapy in postmenopausal osteopenic or osteoporotic women who cannot or will not tolerate ovarian hormone therapy. They should also be considered in treating male osteoporosis and steroid-induced bone loss. Combination therapy with estrogen may be effective, although more research is needed. Combination therapy with calcium supplements is recommended. Bisphosphonate therapies should be restricted to postmenopausal patients with osteopenia or established osteoporosis and are not yet recommended for younger perimenopausal women as prophylaxis.

Authors+Show Affiliations

Department of Medicine, University of Western Ontario, St. Joseph's Health Centre, London.No affiliation info availableNo affiliation info available

Pub Type(s)

Consensus Development Conference
Journal Article
Review

Language

eng

PubMed ID

8837544

Citation

Hodsman, A, et al. "Prevention and Management of Osteoporosis: Consensus Statements From the Scientific Advisory Board of the Osteoporosis Society of Canada. 6. Use of Bisphosphonates in the Treatment of Osteoporosis." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 155, no. 7, 1996, pp. 945-8.
Hodsman A, Adachi J, Olszynski W. Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 6. Use of bisphosphonates in the treatment of osteoporosis. CMAJ. 1996;155(7):945-8.
Hodsman, A., Adachi, J., & Olszynski, W. (1996). Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 6. Use of bisphosphonates in the treatment of osteoporosis. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 155(7), 945-8.
Hodsman A, Adachi J, Olszynski W. Prevention and Management of Osteoporosis: Consensus Statements From the Scientific Advisory Board of the Osteoporosis Society of Canada. 6. Use of Bisphosphonates in the Treatment of Osteoporosis. CMAJ. 1996 Oct 1;155(7):945-8. PubMed PMID: 8837544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 6. Use of bisphosphonates in the treatment of osteoporosis. AU - Hodsman,A, AU - Adachi,J, AU - Olszynski,W, PY - 1996/10/1/pubmed PY - 1996/10/1/medline PY - 1996/10/1/entrez SP - 945 EP - 8 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 155 IS - 7 N2 - OBJECTIVE: To describe the mechanisms of action of bisphosphonates in the treatment of osteoporosis and compare bisphosphonate therapy with other treatments. OPTIONS: The bisphosphonates, etidronate, alendronate, clodronate, pamidronate, tiludronate, ibandronate and risedronate; combined bisphosphonates and estrogen; combined bisphosphonates and calcium supplements. OUTCOMES: Fracture and loss of bone mineral density in osteoporosis; increased bone mass, prevention of fractures and improved quality of life associated with bisphosphonate treatment. EVIDENCE: Relevant clinical studies and reports were examined with emphasis on recent controlled trials. The availability of treatment products in Canada was also considered. VALUES: Reducing fractures, increasing bone mineral density and minimizing side effects of treatment were given a high value. BENEFITS, HARMS AND COSTS: Treatment with bisphosphonates may be an acceptable alternative to ovarian hormone therapy in increasing bone mass and decreasing fractures associated with osteoporosis. Compared with estrogens, bisphosphonates are bone-tissue specific, have equal or greater antiresorptive effect and have few side effects and no known risk for carcinogenesis. They also hold promise in treating male osteoporosis and steroid-induced bone loss. Prolonged, continuous treatment with etidronate may lead to impaired calcification of newly formed bone; therefore, etidronate is administered cyclically. This risk is not present in newer generations of bisphosphonates. RECOMMENDATIONS: Bisphosphonate therapies may be considered as an alternative to ovarian hormone therapy in postmenopausal osteopenic or osteoporotic women who cannot or will not tolerate ovarian hormone therapy. They should also be considered in treating male osteoporosis and steroid-induced bone loss. Combination therapy with estrogen may be effective, although more research is needed. Combination therapy with calcium supplements is recommended. Bisphosphonate therapies should be restricted to postmenopausal patients with osteopenia or established osteoporosis and are not yet recommended for younger perimenopausal women as prophylaxis. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/8837544/Prevention_and_management_of_osteoporosis:_consensus_statements_from_the_Scientific_Advisory_Board_of_the_Osteoporosis_Society_of_Canada__6__Use_of_bisphosphonates_in_the_treatment_of_osteoporosis_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=reprint&pmid=8837544 DB - PRIME DP - Unbound Medicine ER -