Lower incidence of broken bones reason for osteoporosis treatment
November 6, 2001 | 12:00am
Improved patient compliance also stressed
The chief consideration when treating osteoporosis sufferers should be to decrease the incidence of fragility fractures. But improving compliance among patients with osteoporosis should also be an important factor in managing the disease. These were emphasized by Professor Pierre D. Delmas, professor of Medicine at the Universite Claude Bernard of Lyon, France and director of the INSERM Research Unit 403 on Pathophysiology of Osteoporosis at the Hospital Edouard Herriot, during a scientific lecture held recently at the Makati Shangri-La Hotel in celebration of the World Osteoporosis Month which is October.
According to Delmas, many treatments have been suggested in managing osteoporosis but only a few have addressed the issue of anti-fracture efficacy and patient compliance. Though calcium and low dose vitamin D supplementation are valuable for osteoporosis sufferers and in elderly institutionalized women, in most cases these are not enough to substantially decrease fracture risk.
Delmas, who is also president of the International Osteoporosis Foundation (IOF), said that in most western countries, hormone replacement therapy (HRT) is considered as the "gold standard" for the prevention of osteoporosis, although anti-fracture efficacy is mainly derived from cohort and case-control studies. A major problem with HRT is low compliance, resulting in cessation of treatment within one year in about half of patients. He added that there are, however, women who cannot or do not want to take HRT, especially for fear of breast cancer, and effective alternatives are necessary.
With the development of a new class of agents such as the bisphosphonates, the most potent inhibitors of bone resorption that have been used in a variety of metabolic bone diseases, including osteoporosis, incidence of fractures have been reduced. Alendronate sodium is the first bisphosphonate widely available for which there is consistent and convincing evidence of anti-fracture efficacy.
In patients with osteoporosis, alendronate sodium reduces the incidence of vertebral fractures by about 50% and the incidence of non-vertebral fractures (including the hip) by 30% to 50%. The anti-fracture efficacy is consistent across studies and occurs early, within 12 to 18 months of therapy according to the type of fracture.
To address compliance, Delmas discussed a new study on alendronate sodium showing that by simplifying the dosing regimen from once-daily to once-weekly, patient convenience has improved. "In the study, nearly nine out of 10 postmenopausal women with osteoporosis preferred a 70mg once-weekly dosing regimen of alendronate sodium over a 10mg once-daily regimen. The study was conducted to learn more about patient preference and convenience and it showed that an overwhelming number of patients preferred the once-weekly dosing because it was more convenient compared to once-daily dosing."
"The study also showed that the new dosage strength of 70mg had an equivalent effect to once a day in increasing bone mineral density (BMD) among postmenopausal women. The safety and tolerability profiles in both treatment groups were found to be similar and there were no significant differences between the two dosing regimens in upper gastrointestinal (GI) adverse events."
Delmas concluded his lecture by pointing out that convenience of long-term treatment plays a key role when it comes to compliance considering the age bracket of osteoporosis sufferers.
Alendronate sodium, marketed as Fosamax in the Philippines, like other bisphosphonates, should be used with caution in people with certain stomach or digestive problems. Patients are encouraged to always consult their doctor in the management and treatment of osteoporosis.
The chief consideration when treating osteoporosis sufferers should be to decrease the incidence of fragility fractures. But improving compliance among patients with osteoporosis should also be an important factor in managing the disease. These were emphasized by Professor Pierre D. Delmas, professor of Medicine at the Universite Claude Bernard of Lyon, France and director of the INSERM Research Unit 403 on Pathophysiology of Osteoporosis at the Hospital Edouard Herriot, during a scientific lecture held recently at the Makati Shangri-La Hotel in celebration of the World Osteoporosis Month which is October.
According to Delmas, many treatments have been suggested in managing osteoporosis but only a few have addressed the issue of anti-fracture efficacy and patient compliance. Though calcium and low dose vitamin D supplementation are valuable for osteoporosis sufferers and in elderly institutionalized women, in most cases these are not enough to substantially decrease fracture risk.
Delmas, who is also president of the International Osteoporosis Foundation (IOF), said that in most western countries, hormone replacement therapy (HRT) is considered as the "gold standard" for the prevention of osteoporosis, although anti-fracture efficacy is mainly derived from cohort and case-control studies. A major problem with HRT is low compliance, resulting in cessation of treatment within one year in about half of patients. He added that there are, however, women who cannot or do not want to take HRT, especially for fear of breast cancer, and effective alternatives are necessary.
With the development of a new class of agents such as the bisphosphonates, the most potent inhibitors of bone resorption that have been used in a variety of metabolic bone diseases, including osteoporosis, incidence of fractures have been reduced. Alendronate sodium is the first bisphosphonate widely available for which there is consistent and convincing evidence of anti-fracture efficacy.
In patients with osteoporosis, alendronate sodium reduces the incidence of vertebral fractures by about 50% and the incidence of non-vertebral fractures (including the hip) by 30% to 50%. The anti-fracture efficacy is consistent across studies and occurs early, within 12 to 18 months of therapy according to the type of fracture.
To address compliance, Delmas discussed a new study on alendronate sodium showing that by simplifying the dosing regimen from once-daily to once-weekly, patient convenience has improved. "In the study, nearly nine out of 10 postmenopausal women with osteoporosis preferred a 70mg once-weekly dosing regimen of alendronate sodium over a 10mg once-daily regimen. The study was conducted to learn more about patient preference and convenience and it showed that an overwhelming number of patients preferred the once-weekly dosing because it was more convenient compared to once-daily dosing."
"The study also showed that the new dosage strength of 70mg had an equivalent effect to once a day in increasing bone mineral density (BMD) among postmenopausal women. The safety and tolerability profiles in both treatment groups were found to be similar and there were no significant differences between the two dosing regimens in upper gastrointestinal (GI) adverse events."
Delmas concluded his lecture by pointing out that convenience of long-term treatment plays a key role when it comes to compliance considering the age bracket of osteoporosis sufferers.
Alendronate sodium, marketed as Fosamax in the Philippines, like other bisphosphonates, should be used with caution in people with certain stomach or digestive problems. Patients are encouraged to always consult their doctor in the management and treatment of osteoporosis.
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