Introduction: Many drugs are now available for the prevention and treatment of osteoporosis. They have differing levels of evidence of efficacy and each may be used according to clinical indications.Methods: A Medline search of clinical drug trials using various therapeutic agents used for osteoporosis was carried out. Results: Several randomised controlled trials have been carried out using many agents. The agents with the best data to date with regards to the prevention of spine as well as hip fractures in patients with prevalent fractures belong to alendronate and risedronate. Parathyroid hormone has been shown in one trial to reduce the risk of non-vertebral fractures. For reduction of spine fractures, in addition to the above two bisphosphonates, many agents, in particular raloxifene, have been shown to be clearly beneficial. Weaker data exist for hormone replacement, calcitonin, cyclical etidronate and the vitamin D analogues calcitriol and alfacalcidol. Conclusion: There are many therapeutic agents shown to be clearly effective in the treatment of osteoporosis.
The current practice and management of osteoporosis differs greatly from even the recent past. Up to 15 years ago, bone mineral density (BMD) measurements were not widely available, osteoporosis was still largely diagnosed only at the stage of fractures, the epidemiology of osteoporosis was not well studied yet and the only medications that were indicated for osteoporosis were hormone replacement therapy (HRT) and calcitonin.
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