Abstract and Introduction
Purpose of review Osteoporosis is a skeletal disorder in which bone strength is decreased leading to an increased risk of fracture. In line with advances in knowledge of bone biology, the past several years have held major therapeutic advances in osteoporosis treatment. In this article, we review the current approaches to osteoporosis treatment with a focus on issues of interest to the practicing rheumatologist.
Recent findings In addition to the bisphosphonates, the introduction of denosumab, teriparatide and selective oestrogen-receptor modulators, as well as the development of new therapeutic agents (romosozumab and odanacatib) has opened the door to new approaches, including individualization of treatment in different clinical circumstances based on patient comorbidities and preference; combination therapy to optimize treatment effect; and consideration of goal-based treatment. Postmarketing surveillance of bisphosphonates has revealed several safety concerns including osteonecrosis of the jaw and atypical femoral fractures. Bisphosphonate drug holidays should be considered in patients on bisphosphonate therapy because prolonged treatment may be associated with adverse events.
Summary Substantial progress has been made in the past several years in the understanding and modification of osteoporosis management. Many conditions encountered by rheumatologists are associated with bone loss; therefore, the rheumatologist needs to be aware of the current approaches in osteoporosis management.
Osteoporosis is a disorder of major societal impact, and osteoporotic fractures are associated with significant disease burden, healthcare cost, morbidity and mortality. Osteoporotic fractures, particularly hip fractures, result in disability related to difficulty with ambulation and the performance of activities of daily living and are thus associated with increased nursing home and rehabilitation hospital admissions. The mortality rates for both men and women who have sustained hip or vertebral fragility fractures are increased as compared with the general population, especially in the first year postfracture. Many inflammatory conditions that rheumatologists encounter, including rheumatoid arthritis (RA), psoriatic arthritis and ankylosing spondylitis, are associated with osteoporosis. In addition, in the daily practice of rheumatology, glucocorticoids, a major risk factor for osteoporosis, are frequently prescribed. In this article, we review the current approaches to osteoporosis treatment with a focus on issues that are of interest to the practicing rheumatologist.