Vnitr Lek 2024, 70(2):E7-E23 | DOI: 10.36290/vnl.2024.028

Pharmacological treatment of osteoporosis and prevention of fractures: recommendations for clinical practice

Vít Zikán

3. interní klinika VFN a 1. LF UK, Praha

The clinical significance of osteoporosis lies in the low-trauma fractures that arise. Fractures lead to increased morbidity, excess mortality, decreased quality of life and loss of autonomy. Management of osteoporosis involves assessing risk factors for fracture, reducing modifiable risk factors through dietary and lifestyle changes, and the use of pharmacologic therapy for patients at significant risk of fractures. Osteoporosis is a chronic condition and therefore needs a long-term management plan with a personalized approach to treatment. Current medications build bone and/or decrease bone breakdown and reduce incident fractures. In individuals at high risk of fracture, the benefit versus risk profile is likely to be favourable for up to 10 years of treatment with bisphosphonates or denosumab. However, denosumab should not be stopped without considering alternative treatment in order to prevent rapid BMD loss and a potential rebound in vertebral fracture risk. In people at a very high risk of fracture, therapy with teriparatide or romosozumab should be considered in the first choice; however, since treatment duration with these drugs is restricted to 12-24 months, treatment should be continued with an antiresorptive drug. Early diagnosis and appropriate management of skeletal fragility can dramatically reduce fractures, and preserve mobility, autonomy, and quality of life.

Keywords: osteoporosis, fracture risk, antiresorptive and osteoanabolic drugs.

Accepted: April 10, 2024; Published: April 10, 2024  Show citation