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Osteoporosis treatment: a missed opportunity

Frances Milat and Peter R Ebeling
Med J Aust 2016; 205 (4): 185-190. || doi: 10.5694/mja16.00568

Summary

  • Osteoporosis affects 1.2 million Australians and, in 2012, fractures due to osteoporosis and osteopenia in Australians aged over 50 years cost $2.75 billion.
  • Even minor minimal trauma fractures are associated with increased morbidity and mortality.
  • Despite increasing therapeutic options for managing osteoporosis, fewer than 20% of patients with a minimal trauma fracture are treated or investigated for osteoporosis, so under-treatment is extremely common.
  • Fracture risk assessment is important for selecting patients who require specific anti-osteoporosis therapy.
  • Post-menopausal osteoporosis is frequently due to an imbalance in bone remodelling, with bone resorption exceeding bone formation.
  • Antiresorptive drugs reduce the number, activity and lifespan of osteoclasts, and include bisphosphonates, oestrogen, selective oestrogen receptor-modulating drugs, strontium ranelate, and the human monoclonal antibody denosumab.
  • Teriparatide is the only anabolic agent currently available that stimulates osteoblast recruitment and activity; its antifracture efficacy for non-vertebral fractures increases with the duration of therapy for up to 2 years when it is associated with persisting increases in bone formation rate at the tissue level.
  • Newer anabolic agents are imminent and include an analogue of parathyroid hormone-related protein, abaloparatide, and a humanised monoclonal antibody to an inhibitor of bone formation, romosozumab.
  • Selection of anti-osteoporosis therapy should be individualised to patients, and the duration of bisphosphonate therapy has been covered in recent guidelines.
  • The benefits of treatment far outweigh any risks associated with long term treatment.
  • General practitioners need to take up the challenge imposed by osteoporosis and become champions of change to close the evidence–treatment gap.

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  • Frances Milat1,2
  • Peter R Ebeling1

  • 1 Monash University, Melbourne, VIC
  • 2 Monash Medical Centre, Melbourne, VIC

Correspondence: peter.ebeling@monash.edu

Competing interests:

Peter Ebeling has received research funding from Merck, Novartis, Amgen and Eli Lilly, and honoraria from Amgen and Eli Lilly.

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