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Introduction: Management Of Osteoporosis, 1997
Introduction: Management of Osteoporosis, 1997 NELSON B. WATTS, MD
I
n this second volume of The American Journal of the Medical Sciences devoted to the subject of osteoporosis, pharmacologic measures for prevention and treatment are reviewed. Dr. Notelovitz discusses estrogen, which most experts agree is the agent of choice for both prevention and treatment of postmenopausal osteoporosis. However, osteoporosis also affects men, and many women cannot or will not take estrogen. In addition, between 10% and 15% of women taking estrogen lose bone. Alternatives are needed. Until late 1995, the only FDA-approved alternative to estrogen was salmon calcitonin by injection. Dr. Silverman describes experience with injectable calcitonin and the role of the recently released nasal spray form of calcitonin. Bisphosphonates are the most popular alternative to estrogen, at least in the United States and Europe. Dr. Licata reviews the history of these agents and the recent studies that lead to the approval of alendronate by the FDA in 1995. From The Emory Clinic, Section of Internal Medicine, Endocrinology and Diabetes, Atlanta, GA. Submitted July 31, 1996; accepted July 31, 1996. Correspondence: Nelson B. Watts, MD, The Emory Clinic, Section of Internal Medicine, Endocrinology and Diabetes, Building A, Fourth Floor, 1365 Clifton Road NE, Atlanta, GA 30322.
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Fluoride has been suggested for the treatment of osteoporosis for several decades; some studies have shown benefits whereas others have shown an increased risk of fractures, at least with high-dose fluoride. Dr. Pak and colleagues have been instrumental in keeping the case for fluoride treatment open and report encouraging results with a slow-release fluoride regimen. Many other therapeutic agents are used to treat osteoporosis in specific circumstances, and many exciting agents are in various stages of development. These are reviewed by Dr. Reginster. Finally, long-term glucocorticoid use is invariably associated with bone loss and is often associated with fractures. Dr. Adachi reviews the specific pathophysiology and the benefits of various approaches to both prevention and treatment. These advances in the evaluation and management of osteoporosis, a common and potentially crippling condition, emphasize Dr. Lindsay's observation that "osteoporosis is a treatable and preventable condition, and should not be considered an inevitable consequence of aging."! References 1. Lindsay R. Osteoporosis, A Guide to Diagnosis, Prevention,
and Treatment. New York: Raven Press; 1992.
I
n this second volume of The American Journal of the Medical Sciences devoted to the subject of osteoporosis, pharmacologic measures for prevention and treatment are reviewed. Dr. Notelovitz discusses estrogen, which most experts agree is the agent of choice for both prevention and treatment of postmenopausal osteoporosis. However, osteoporosis also affects men, and many women cannot or will not take estrogen. In addition, between 10% and 15% of women taking estrogen lose bone. Alternatives are needed. Until late 1995, the only FDA-approved alternative to estrogen was salmon calcitonin by injection. Dr. Silverman describes experience with injectable calcitonin and the role of the recently released nasal spray form of calcitonin. Bisphosphonates are the most popular alternative to estrogen, at least in the United States and Europe. Dr. Licata reviews the history of these agents and the recent studies that lead to the approval of alendronate by the FDA in 1995. From The Emory Clinic, Section of Internal Medicine, Endocrinology and Diabetes, Atlanta, GA. Submitted July 31, 1996; accepted July 31, 1996. Correspondence: Nelson B. Watts, MD, The Emory Clinic, Section of Internal Medicine, Endocrinology and Diabetes, Building A, Fourth Floor, 1365 Clifton Road NE, Atlanta, GA 30322.
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Fluoride has been suggested for the treatment of osteoporosis for several decades; some studies have shown benefits whereas others have shown an increased risk of fractures, at least with high-dose fluoride. Dr. Pak and colleagues have been instrumental in keeping the case for fluoride treatment open and report encouraging results with a slow-release fluoride regimen. Many other therapeutic agents are used to treat osteoporosis in specific circumstances, and many exciting agents are in various stages of development. These are reviewed by Dr. Reginster. Finally, long-term glucocorticoid use is invariably associated with bone loss and is often associated with fractures. Dr. Adachi reviews the specific pathophysiology and the benefits of various approaches to both prevention and treatment. These advances in the evaluation and management of osteoporosis, a common and potentially crippling condition, emphasize Dr. Lindsay's observation that "osteoporosis is a treatable and preventable condition, and should not be considered an inevitable consequence of aging."! References 1. Lindsay R. Osteoporosis, A Guide to Diagnosis, Prevention,
and Treatment. New York: Raven Press; 1992.