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Osteoporosis treatment and the older patient

Published online by Cambridge University Press:  24 February 2011

Roger H Jay*
Affiliation:
Department of Geriatric Medicine, Freeman Hospital, Newcastle upon Tyne, UK
Sarah L Marrinan
Affiliation:
Department of Geriatric Medicine, Freeman Hospital, Newcastle upon Tyne, UK
*
Address for correspondence: Dr Roger H Jay, Consultant Geriatrician, Level 6, Freeman Hospital, Newcastle upon Tyne NE7 7DN. Email: roger.jay@nuth.nhs.uk

Summary

Osteoporosis is a common, chronic condition. Fracture risk assessment tools are increasingly being used to identify those patients who may benefit from treatment, but in older patients clinical judgement is still essential in deciding whom to treat. The treatment of osteoporosis in older people has seen several important developments in recent years. Whilst bisphosphonates are the mainstay of treatment, several newer medications have proven benefit in terms of increases in bone mineral density and fracture prevention. Additionally, some of the newer therapies have characteristics that particularly lend themselves to use in an older population group. This article focuses upon treatment of osteoporosis in older people with an emphasis on newer drug and therapeutic options.

Type
Clinical geriatrics
Copyright
Copyright © Cambridge University Press 2011

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References

1World Health Organisation Scientific Group on the assessment of osteoporosis at the primary health care level. Summary Meeting Report. World Health Organisation 2007.Google Scholar
2Reginster, JY, Burlet, N. Osteoporosis: still increasing prevalence. Bone 2006; 38 (suppl 1): S49.CrossRefGoogle ScholarPubMed
3Torgerson, D, Iglesias, C, Reid, DM. The effective management of osteoporosis. The Economics of Fracture Prevention 2001; pp. 111–121.Google Scholar
4Jay, RH. Treatment of osteoporosis in old age. Rev Clin Gerontol 2005; 15: 8390.CrossRefGoogle Scholar
5FRAX: WHO Fracture Risk Assessment Tool. FRAX 2010; available at: http://www.shef.ac.uk/FRAX/index.jsp (accessed 19 December 2010).Google Scholar
6NOGG: National Osteoporosis Guideline Group. NOGG 2010; available at: http://www.shef.ac.uk/NOGG/ (accessed 19 December 2010).Google Scholar
7NICE technology appraisal guidance 161 (amended). NICE 2010; available at: http://www.nice.org.uk/nicemedia/live/11748/47177/47177.pdf (accessed 19 December 2010).Google Scholar
8Qfracture. Qfracture 2010; available at: http://www.qfracture.org (accessed 19 December 2010).Google Scholar
9Reid, IR, Mason, B, Horne, A, Ames, R, Reid, HE, Bava, U, Bolland, MJ, Gamble, GD. Randomised controlled trial of calcium in helathy older women. Am J Med 2006; 119: 777–85.CrossRefGoogle Scholar
10Shea, B, Wells, G, Cranney, A, Zytaruk, N, Robinson, V, Griffith, L, Ortiz, Z, Peterson, J, Adachi, J, Tugwell, P, Guyatt, G; Osteoporosis Methodology Group and The Osteoporosis Research Advisory Group. Meta-analysis of calcium supplementation for the prevention of post-menopausal osteoporosis. Endocr Rev 2002; 23: 552–59.CrossRefGoogle Scholar
11Bischoff-Ferrari, HA, Dawson-Hughes, B, Baron, JA, Burckhardt, P, Li, R, Spiegelman, D, Specker, B, Orav, JE, Wong, JB, Staehelin, HB, O'Reilly, E, Kiel, DP, Willett, WC. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr 2007; 86: 1780–90.CrossRefGoogle ScholarPubMed
12Tang, BMP, Eslick, GD, Nowson, C, Smith, C, Bensoussan, A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370: 657–66.CrossRefGoogle ScholarPubMed
13Reid, IR, Bolland, MJ, Grey, A. Effect of calcium supplementation on hip fractures. Osteoporosis Int 2008; 19: 1119–23.CrossRefGoogle ScholarPubMed
14Bolland, MJ, Avenell, A, Baron, JA, Grey, A, MacLennan, GS, Gamble, GD, Reid, IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010; 341: c3691.CrossRefGoogle ScholarPubMed
15Hsia, J, Geraldo, H, Hong, R et al. Calcium/vitamin D supplementation and cardiovascular events. Circulation 2007; 115: 846–54.CrossRefGoogle ScholarPubMed
16Hyponen, E, Power, C. Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors. Am J Clin Nutr 2007; 85: 860–68.CrossRefGoogle Scholar
17Holick, MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266–81.CrossRefGoogle ScholarPubMed
18Trivedi, DP, Doll, R, Khaw, KT. Effect of four-monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double-blind controlled trial. BMJ 2003; 326: 469.CrossRefGoogle ScholarPubMed
19Heikinheimo, RJ, Inkovaara, JA, Harju, EJ, Haavisto, MV, Kaarela, RH, Kataja, JM, Kokko, AM, Kolho, LA, Rajala, SA. Annual injection of vitamin D and fractures of aged bones. Calcif Tissue Int 1992; 51: 105–10.CrossRefGoogle ScholarPubMed
20Bischoff-Ferrari, HA, Willett, WC, Wong, JB, Stuck, AE, Staehelin, HB, Orav, EJ, Thoma, A, Kiel, DP, Henschkowski, J. Prevention of non-vertebral fractures with oral vitamin D and dose dependency. Archives Intern Med 2009; 169: 551–61.CrossRefGoogle Scholar
21Meyer, HE, Smedshaug, GB, Kvaavik, E, Falch, JA, Tverdal, A, Pedersen, JI. Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. J Bone Miner Res 2002; 17: 709–15.CrossRefGoogle ScholarPubMed
22Law, M, Withers, H, Morris, J, Anderson, F. Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing 2006; 35: 482–86.CrossRefGoogle ScholarPubMed
23Lyons, RA, Johansen, A, Brophy, S, Newcombe, RG, Phillips, CJ, Lervy, B, Evans, R, Wareham, K, Stone, MD. Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation. Osteoporosis Int 2007; 18: 811–18.CrossRefGoogle Scholar
24Avenell, A, Gillespie, W, Gillespie, L, O'Connell, D. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis (Review). Cochrane Database Syst Rev 2009; 2 (2): CD000227.Google Scholar
25The DIPART (vitamin D Individual Patient Analysis of Randomized Trials) Group. Patient level pooled analysis of 68,500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010; 340: b5463.CrossRefGoogle Scholar
26Lips, P, Graafmans, WC, Ooms, ME, Bezemer, PD, Bouter, LM. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo-controlled clinical trial. Ann Intern Med 1996; 124: 400–6.CrossRefGoogle Scholar
27Smith, H, Anderson, F, Raphael, P, Maslin, S, Crozier, S, Cooper, C. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women – a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology 2007; 46: 1852–57.CrossRefGoogle ScholarPubMed
28Sanders, KM, Stuart, AL, Williamson, EJ, Simpson, JA, Kotowicz, MA, Young, D, Nicholson, GC. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303: 1815–22.CrossRefGoogle ScholarPubMed
29Dawson-Hughes, B, Harris, SS. High-dose vitamin D supplementation: too much of a good thing? JAMA 2010; 303: 1861–62.CrossRefGoogle ScholarPubMed
30Chapuy, MC, Arlot, ME, Duboeuf, F, Brun, J, Crouzet, B, Arnaud, S, Delmas, PD, Meunier, PJ. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992; 327: 1637–42.CrossRefGoogle ScholarPubMed
31The RECORD Trial Group. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005; 365: 1621–28.CrossRefGoogle Scholar
32Jackson, RD, LaCroix, AZ, Gass, M, Wallace, RB, Robbins, J, Lewis, CE, Bassford, T, Beresford, SA, Black, HR, Blanchette, P, Bonds, DE, Brunner, RL, Brzyski, RG, Caan, B, Cauley, JA, Chlebowski, RT, Cummings, SR, Granek, I, Hays, J, Heiss, G, Hendrix, SL, Howard, BV, Hsia, J, Hubbell, FA, Johnson, KC, Judd, H, Kotchen, JM, Kuller, LH, Langer, RD, Lasser, NL, Limacher, MC, Ludlam, S, Manson, JE, Margolis, KL, McGowan, J, Ockene, JK, O'Sullivan, MJ, Phillips, L, Prentice, RL, Sarto, GE, Stefanick, ML, Van Horn, L, Wactawski-Wende, J, Whitlock, E, Anderson, GL, Assaf, AR, Barad, D; Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354: 669–83.CrossRefGoogle ScholarPubMed
33Boonen, S, Lips, P, Bouillion, R, Bischoff-Ferrari, HA, Vanderschueren, D, Haentjens, P. Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative meta-analysis of randomized controlled trials. J Clin Endocrinol Metab 2007; 92: 1415–23.CrossRefGoogle Scholar
34Chesnut, CH III, Skag, A, Christiansen, C et al. . Effects of oral ibandronate administered daily or intermittently on fracture risk in post-menopausal osteoporosis. J Bone Miner Res 2004; 19: 1241–49.CrossRefGoogle ScholarPubMed
35Delmas, PD, Recker, RR, Chesnut, CH 3rd, Skag, A, Stakkestad, JA, Emkey, R, Gilbride, J, Schimmer, RC, Christiansen, C. Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study. Osteoporosis Int 2004; 15: 792–98.CrossRefGoogle ScholarPubMed
36Stakkestad, JA, Lakatos, P, Lorenc, R, Sedarati, F, Neale, C, Reginster, JY. Monthly oral Ibandronate is effective and well tolerated after 3 years: The MOBILE Long-term extension. Clinical Rheumatol 2008; 27: 955–60.CrossRefGoogle ScholarPubMed
37Lyles, KW, Conon-Emeric, CS, Magaziner, JS, Adachi, JD, Pieper, CF, Mautalen, C. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357: 1799–809.CrossRefGoogle ScholarPubMed
38Eriksen, EF, Lyles, KW, Colon-Emeric, CS et al. . Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Mineral Res 2009; 24: 1308–13.CrossRefGoogle ScholarPubMed
39Black, DM, Delmas, PD, Eastell, R, Reid, IR, Boonen, S, Cauley, JA, Cosman, F, Lakatos, P, Leung, PC, Man, Z, Mautalen, C, Mesenbrink, P, Hu, H, Caminis, J, Tong, K, Rosario-Jansen, T, Krasnow, J, Hue, TF, Sellmeyer, D, Eriksen, EF, Cummings, SR; HORIZON Pivotal Fracture Trial. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007; 356: 1809–22.CrossRefGoogle ScholarPubMed
40Eastell, R, Black, DM, Boonen, S, Adami, S, Felsenberg, D, Lippuner, K, Cummings, SR, Delmas, PD, Palermo, L, Mesenbrink, P, Cauley, JA; HORIZON Pivotal Fracture Trial. Effect of once-yearly zoledronic acid five milligrams on fracture risk and change in femoral neck bone mineral density. J Clin Endocrinol Metab 2009; 94: 3215–25.CrossRefGoogle ScholarPubMed
41Boonen, S, Black, DM, Colón-Emeric, CS, Eastell, R, Magaziner, JS, Eriksen, EF, Mesenbrink, P, Haentjens, P, Lyles, KW. Efficacy and safety of a once-yearly intravenous zoledronic acid 5 mg for fracture prevention in elderly postmenopausal women with osteoporosis aged 75 and older. J Am Geriatr Soc 2010; 58: 292–99.CrossRefGoogle Scholar
42Black, DM, Cummings, SR, Karpf, DB, Cauley, JA, Thompson, DE, Nevitt, MC, Bauer, DC, Genant, HK, Haskell, WL, Marcus, R, Ott, SM, Torner, JC, Quandt, SA, Reiss, TF, Ensrud, KE. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996; 348: 1535–41.CrossRefGoogle ScholarPubMed
43Cummings, SR, Black, DM, Thompson, DE, Applegate, WB, Barrett-Connor, E, Musliner, TA, Palermo, L, Prineas, R, Rubin, SM, Scott, JC, Vogt, T, Wallace, R, Yates, AJ, LaCroix, AZ. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998; 280: 2077–82.CrossRefGoogle ScholarPubMed
44Heckbert, SR, Li, G, Cummings, SR, Smith, NL, Psaty, BM. Use of alendronate and risk of incident atrial fibrillation in women. Archives Intern Med 2008; 168: 826–31.CrossRefGoogle ScholarPubMed
45Abrahamsen, B, Eiken, P, Brixen, K. Atrial fibrillation in fracture patients treated with oral bisphosphonates. J Intern Med 2009; 265: 581–92.CrossRefGoogle ScholarPubMed
46Reginster, JY, Adami, S, Lakatos, P, Greenwald, M, Stepan, JJ, Silverman, SL, Christiansen, C, Rowell, L, Mairon, N, Bonvoisin, B, Drezner, MK, Emkey, R, Felsenberg, D, Cooper, C, Delmas, PD, Miller, PD. Efficacy and tolerability of once-monthly oral ibandronate in postmenopausal osteoporosis: 2 year results from the MOBILE study. Ann Rheum Dis 2006; 65: 654–61.CrossRefGoogle ScholarPubMed
47Lenart, B, Lorich, D, Lane, J. Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med 2008; 358: 1304–5.CrossRefGoogle ScholarPubMed
48Abrahamsen, B, Eiken, P, Eastell, R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res 2009; 24: 1095–102.CrossRefGoogle ScholarPubMed
49Black, DM, Kelly, MP, Genant, HK, Palermo, L, Eastell, R, Bucci-Rechtweg, C, Cauley, J, Leung, PC, Boonen, S, Santora, A, de Papp, A, Bauer, DC; Fracture Intervention Trial Steering Committee; HORIZON Pivotal Fracture Trial Steering Committee. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med 2010; 362: 1761–71.CrossRefGoogle ScholarPubMed
50Bauer, DC, Black, D, Ensrud, K, Thompson, D, Hochberg, M, Nevitt, M, Musliner, T, Freedholm, D. Upper gastrointestinal tract safety profile of alendronate: the Fracture Intervention Trial. Archives Intern Med 2000; 160: 517–25.CrossRefGoogle ScholarPubMed
51Harris, ST, Watts, NB, Genant, HK, McKeever, CD, Hangartner, T, Keller, M, Chesnut, CH 3rd, Brown, J, Eriksen, EF, Hoseyni, MS, Axelrod, DW, Miller, PD. Effects of risedronate treatment on vertebral and non-vertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate (VERT). JAMA 1999; 282: 1344–52.CrossRefGoogle Scholar
52Reginster, J, Minne, HW, Sorensen, OH, Hooper, M, Roux, C, Brandi, ML, Lund, B, Ethgen, D, Pack, S, Roumagnac, I, Eastell, R. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporosis Int 2000; 11: 8391.CrossRefGoogle ScholarPubMed
53Sorensen, OH, Crawford, GM, Mulder, H, Hosking, DJ, Gennari, C, Mellstrom, D, Pack, S, Wenderoth, D, Cooper, C, Reginster, JY. Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience. Bone 2003; 32: 120–26.CrossRefGoogle ScholarPubMed
54Taggart, H, Bolognese, MA, Lindsay, R, Ettinger, MP, Mulder, H, Josse, RG, Roberts, A, Zippel, H, Adami, S, Ernst, TF, Stevens, KP. Upper gastrointestinal tract safety of risedronate: a pooled analysis of 9 clinical trials. Mayo Clin Proc 2002; 77: 262–70.CrossRefGoogle ScholarPubMed
55Cadarette, SM, Katz, JN, Brookhart, MA, Stürmer, T, Stedman, MR, Levin, R, Solomon, DH. Comparative gastrointestinal safety of weekly oral bisphosphonates. Osteoporosis Int 2009; 20: 1735–47.CrossRefGoogle ScholarPubMed
56Blumentals, WA, Harris, ST, Cole, RE, Huang, L, Silverman, SL. Risk of severe gastrointestinal events in women treated with monthly ibandronate or weekly alendronate and risedronate. Ann Pharmacother 2009; 43: 577–85.CrossRefGoogle ScholarPubMed
57Wysowski, DK. Reports of esophageal cancer with oral bisphosphonate use. N Engl J Med 2009; 360: 8990.CrossRefGoogle ScholarPubMed
58Solomon, DH, Patrick, A, Brookhart, MA. More on reports of esophageal cancer with oral bisphosphonate use. N Engl J Med 2009; 360: 1789–90.Google ScholarPubMed
59Green, J, Czanner, G, Reeves, G, Watson, J, Wise, L, Beral, V. Oral bisphosphonates and risk of cancer of oesophagus, stomach and colorectum: nested case-control study. BMJ 2010; 341: c4444.CrossRefGoogle Scholar
60Cardwell, CR, Abnet, CC, Cantwell, MM, Murray, LJ. Exposure to oral bisphosphonates and risk of esophageal cancer. JAMA 2010; 304: 657–63.CrossRefGoogle ScholarPubMed
61Questions and answers on the study by Green and co-workers (2010) on oral bisphosphonates and oesophageal cancer. MHRA 2010; available at: www.mhra.gov.uk (accessed 19 December 2010).Google Scholar
62Meunier, PJ, Roux, C, Ortolani, S, Diaz-Curiel, M, Compston, J, Marquis, P, Cormier, C, Isaia, G, Badurski, J, Wark, JD, Collette, J, Reginster, JY. Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis. Osteoporosis Int 2009; 20: 1663–73.CrossRefGoogle ScholarPubMed
63Reginster, JY, Seeman, E, De Vernejoul, MC, Adami, S, Compston, J, Phenekos, C, Devogelaer, JP, Curiel, MD, Sawicki, A, Goemaere, S, Sorensen, OH, Felsenberg, D, Meunier, PJ. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) Study. J Clin Endocrinol Metab 2005; 90: 2816–22.CrossRefGoogle ScholarPubMed
64Reginster, JY, Felsenberg, D, Boonen, S, Diez-Perez, A, Rizzoli, R, Brandi, ML, Spector, TD, Brixen, K, Goemaere, S, Cormier, C, Balogh, A, Delmas, PD, Meunier, PJ. Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis: Results of a five-year, randomized, placebo-controlled trial. Arthritis Rheum 2008; 58: 1687–95.CrossRefGoogle ScholarPubMed
65Seeman, E, Vellas, B, Benhamou, C, Aquino, JP, Semler, J, Kaufman, JM, Hoszowski, K, Varela, AR, Fiore, C, Brixen, K, Reginster, JY, Boonen, S. Strontium ranelate reduces the risk of vertebral and nonvertebral fractures in women eighty years of age and older. J Bone Miner Res 2006; 21: 1113–20.CrossRefGoogle ScholarPubMed
66Rolland, Y, Van Kan, GA, Gillette-Guyonnet, S, Roux, C, Boonen, S, Vellas, B. Strontium ranelate and risk of vertebral fractures in frail osteoporotic women. Bone 2010; Epub ahead of print (15 Sept).CrossRefGoogle Scholar
67Neer, RM, Arnaud, CD, Zanchetta, JR, Prince, R, Gaich, GA, Reginster, JY, Hodsman, AB, Eriksen, EF, Ish-Shalom, S, Genant, HK, Wang, O, Mitlak, BH. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434–41.CrossRefGoogle ScholarPubMed
68Greenspan, SL, Bone, HG, Ettinger, MP, Hanley, DA, Lindsay, R, Zanchetta, JR, Blosch, CM, Mathisen, AL, Morris, SA, Marriott, TB; Treatment of Osteoporosis with Parathyroid Hormone Study Group. Effect of recombinant human parathyroid hormone (1–84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis. Ann Intern Med 2007; 146: 326–39.CrossRefGoogle Scholar
69Black, DM, Bilezikian, JP, Ensrud, KE, Greenspan, SL, Palermo, L, Hue, T, Lang, TF, McGowan, JA, Rosen, CJ; PaTH Study Investigators. One year of alendronate after one year of parathyroid hormone (1–84) for osteoporosis. N Engl J Med 2005; 353: 555–65.CrossRefGoogle ScholarPubMed
70Finkelstein, JS, Hayes, A, Hunzelman, JL, Wyland, JJ, Lee, H, Neer, RM. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003; 349: 1216–26.CrossRefGoogle ScholarPubMed
71Maugeri, D, Russo, E, Luca, S, Leotta, C, Mamazza, G, Sorace, R, Rizzotto, M, Manuele, S, Fiore, V, Taverna, G, Castiglia, B, Calitro, M. Changes of the quality-of-life under the treatment of severe senile osteoporosis with teriparatide. Arch Gerontol Geriatr 2009; 49: 3538.CrossRefGoogle ScholarPubMed
72Cosman, F et al. . Effects of once-yearly zoledronic acid 5mg in combination with teriparatide (PTH) on postmenopausal women with osteoporosis. ASBMR 2009; poster ref A09002568; available at: http://www.asbmr.org/Meetings/AnnualMeeting/AbstractDetail.aspx?aid=51298f90-2f0a-4b6f-99fd-0e7bbe5eaa44 (accessed 19 December 2010).Google Scholar
73Masud, T et al. . Use of teriparatide in the very elderly: real life data from the UK. Osteoporosis Int 2009; 20 (suppl 4): S305, poster P68.Google Scholar
74Delmas, PD, Ensrud, KE, Adachi, JD, Harper, KD, Sarkar, S, Gennari, C, Reginster, JY, Pols, HA, Recker, RR, Harris, ST, Wu, W, Genant, HK, Black, DM, Eastell, R; Mulitple Outcomes of Raloxifene Evaluation Investigators. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2002; 87: 3609–17.CrossRefGoogle ScholarPubMed
75Ettinger, B, Black, DM, Mitlak, BH, Knickerbocker, RK, Nickelsen, T, Genant, HK, Christiansen, C, Delmas, PD, Zanchetta, JR, Stakkestad, J, Glüer, CC, Krueger, K, Cohen, FJ, Eckert, S, Ensrud, KE, Avioli, LV, Lips, P, Cummings, SR. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene:results from a 3-year randomized clinical trial. JAMA 1999; 282: 637–45.CrossRefGoogle ScholarPubMed
76Cummings, SR, Ensrud, K, Delmas, PD, LaCroix, AZ, Vukicevic, S, Reid, DM, Goldstein, S, Sriram, U, Lee, A, Thompson, J, Armstrong, RA, Thompson, DD, Powles, T, Zanchetta, J, Kendler, D, Neven, P, Eastell, R; PEARL Study Investigators. Lasofoxifene in postmenopausal women with osteoporosis. N Engl J Med 2010; 362: 686–96.CrossRefGoogle ScholarPubMed
77Silverman, SL, Christiansen, C, Genant, HK, Vukicevic, S, Zanchetta, JR, de Villiers, TJ, Constantine, GD, Chines, AA. Efficacy of bazedoxifene in reducing new vertebral fracture risk in postmenopausal women with osteoporosis: results from a 3-year, randomized, placebo-, and active-controlled clinical trial. J Bone Miner Res 2008; 23: 1923–34.CrossRefGoogle ScholarPubMed
78Cummings, SR, San Martin, J, McClung, MR, Siris, ES, Eastell, R, Reid, IR, Delmas, P, Zoog, HB, Austin, M, Wang, A, Kutilek, S, Adami, S, Zanchetta, J, Libanati, C, Siddhanti, S, Christiansen, C; FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009; 361: 756–65.CrossRefGoogle ScholarPubMed
79Smith, MR, Egerdie, B, Hernández Toriz, N, Feldman, R, Tammela, TL, Saad, F, Heracek, J, Szwedowski, M, Ke, C, Kupic, A, Leder, BZ, Goessl, C; Denosumab HALT Prostate Cancer Study Group. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med 2009; 361: 745–55.CrossRefGoogle ScholarPubMed
80Brown, JP, Prince, RL, Deal, C, Recker, RR, Kiel, DP, de Gregorio, LH, Hadji, P, Hofbauer, LC, Alvaro-Gracia, JM, Wang, H, Austin, M, Wagman, RB, Newmark, R, Libanati, C, San Martin, J, Bone, HG. Comparison of the effect of denosumab and aledronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: a randomized, blinded, phase 3 trial. J Bone Miner Res 2009; 24: 153–61.CrossRefGoogle Scholar
81NICE technology appraisal guidance 204. Denosumab for the prevention of osteoporotic fractures in postmenopausal women. NICE 2010; available at: http://guidance.nice.org.uk/TA204/Guidance/pdf/English (accessed 19 December 2010).Google Scholar
82Francis, RM, Aspray, TJ, Hide, G, Sutcliffe, AM, Wilkinson, P. Back pain in osteoporotic vertebral fractures. Osteoporosis Int 2008; 19: 895903.CrossRefGoogle ScholarPubMed
83Klazen, CA, Lohle, PN, de Vries, J, Jansen, FH, Tielbeek, AV, Blonk, MC, Venmans, A, van Rooij, WJ, Schoemaker, MC, Juttmann, JR, Lo, TH, Verhaar, HJ, Van Der Graaf, Y, van Everdingen, KJ, Muller, AF, Elgersma, OE, Halkema, DR, Fransen, H, Janssens, X, Buskens, E, Mali, WP. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 2010; 376: 1085–92.CrossRefGoogle Scholar
84Rousing, R, Anderson, MO, Jespersen, SM, Thomsen, K, Lauritsen, J. Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three months follow-up in a clinical randomized study. Spine 2009; 34: 1349–54.CrossRefGoogle ScholarPubMed
85Wardlaw, D, Cummings, SR, Van Meirhaeghe, J, Bastian, L, Tillman, JB, Ranstam, J, Eastell, R, Shabe, P, Talmadge, K, Boonen, S. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 2009; 373: 1016–24.CrossRefGoogle Scholar
86Buchbinder, R, Osborne, RH, Ebeling, PR, Wark, JD, Mitchell, P, Wriedt, C, Graves, S, Staples, MP, Murphy, B. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 2009; 361: 557–68.CrossRefGoogle ScholarPubMed
87Kallmes, DF, Comstock, BA, Heagerty, PJ, Turner, JA, Wilson, DJ, Diamond, TH, Edwards, R, Gray, LA, Stout, L, Owen, S, Hollingworth, W, Ghdoke, B, Annesley-Williams, DJ, Ralston, SH, Jarvik, JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009; 361: 569–79.CrossRefGoogle ScholarPubMed
88Buchbinder, R, Osborne, RH, Kallmes, DF. Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm. Med J Aust 2009; 191: 476–77.CrossRefGoogle ScholarPubMed
89Noonan, P. Randomized vertebroplasty trials: bad news or sham news? Am J Neuroradiol 2010; 30: 1808–9.CrossRefGoogle Scholar
90Wardlaw, D, Van Meirhaeghe, J. Another chapter for vertebral compression fractures. Lancet 2010; 376: 1031–33.CrossRefGoogle ScholarPubMed