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Vol. 150. Issue 12.
Pages 479-486 (June 2018)
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Vol. 150. Issue 12.
Pages 479-486 (June 2018)
Review
Update on osteoporosis treatment
Tratamiento de la osteoporosis
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Xavier Noguésa,b,c,
Corresponding author
xnogues@hospitaldelmar.cat

Corresponding author.
, Daniel Martinez-Lagunab,c,d,e
a Servicio de Medicina Interna, Hospital del Mar. URFOA-Unidad de Investigación Musculoesquelética, Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, Spain
b CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES) Instituto Carlos III, Madrid, Spain
c Universitat Autònoma de Barcelona, Barcelona, Spain
d Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
e Grupo de Investigación GREMPAL, Instituto Universitario de Investigación en Atención Primaria Jordi Gol, Barcelona, Spain
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Statistics
Figures (2)
Tables (4)
Table 1. Degree of anti-fracture efficacy of each of the approved drugs.
Table 2. Clinical risk factors.
Table 3. Categorization of patients with glucocorticoid-induced osteoporosis.
Table 4. Summary table of the reference studies of the different drugs used in the treatment of osteoporosis with results on decrease in relative risk of fractures and increase in bone mineral density.
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Abstract

Treatment of osteoporosis should be directed primarily towards secondary prevention of fractures.

The occurrence of drug-related adverse effects for the treatment of osteoporosis has led to a reevaluation of the indications, the duration of treatment and even withdrawal of some drugs from the market.

This review has been made from different patient profiles that practitioners will find in usual practice; from patients with hip fracture with cognitive impairment, limitation of their day-to-day living activities and comorbidities, to active patients without any limitations; patients with vertebral fractures and non-vertebral fractures where secondary prevention is highly important.

In general, antiresorptive drugs (alendronate and risedronate) will be the first choice. Zoledronate or denosumab will be indicated in cases of digestive intolerance, poor adherence or an increased risk of hip fracture. Teriparatide will be indicated to patients with 2 or more previous vertebral fractures or very low bone density.

Keywords:
Osteoporosis
Treatment
Fragility fractures
Secondary prevention
Resumen

El tratamiento de la osteoporosis se ha de dirigir principalmente hacia la prevención secundaria de fracturas.

La aparición de efectos adversos relacionados con fármacos para el tratamiento de la osteoporosis ha hecho revaluar las indicaciones, el tiempo de tratamiento e incluso retirar la comercialización de algunos de ellos.

Esta revisión se ha planteado desde diferentes perfiles de pacientes que los facultativos van a encontrarse en la práctica habitual: desde pacientes con fractura de cadera con deterioro cognitivo, limitación de sus actividades para la vida diaria y comorbilidades, hasta pacientes activos y sin ninguna limitación y pacientes con fracturas vertebrales y fracturas no vertebrales en los que la prevención secundaria es realmente importante.

En general, los fármacos antirresortivos (alendronato y risedronato) serán de primera elección. Zoledronato o denosumab estarán indicados en caso de intolerancia digestiva, mala adherencia o con mayor riesgo de fractura de cadera. Teriparatide estará indicado en pacientes con 2 o más fracturas vertebrales previas o con densidad ósea muy baja.

Palabras clave:
Osteoporosis
Tratamiento
Fracturas por fragilidad
Prevención secundaria

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