Effect of Oral Alendronate on Bone Mineral Density and the Incidence of Fractures in Postmenopausal Osteoporosis

BACKGROUND Postmenopausal osteoporosis is a serious health problem, and additional treatments are needed. METHODS We studied the effects of oral alendronate, an aminobisphosphonate, on bone mineral density and the incidence of fractures and height loss in 994 women with postmenopausal osteoporosis. The women were treated with placebo or alendronate (5 or 10 mg daily for three years, or 20 mg for two years followed by 5 mg for one year); all the women received 500 mg of calcium daily. Bone mineral density was measured by dual-energy x-ray absorptiometry. The occurrence of new vertebral fractures and the progression of vertebral deformities were determined by an analysis of digitized radiographs, and loss of height was determined by sequential height measurements. RESULTS The women receiving alendronate had significant, progressive increases in bone mineral density at all skeletal sites, whereas those receiving placebo had decreases in bone mineral density. At three years, the mean (±SE) differences in bone mineral density between the women receiving 10 mg of alendronate daily and those receiving placebo were 8.8±0.4 percent in the spine, 5.9±0.5 percent in the femoral neck, 7.8±0.6 percent in the trochanter, and 2.5±0.3 percent in the total body (P CONCLUSIONS Daily treatment with alendronate progressively increases the bone mass in the spine, hip, and total body and reduces the incidence of vertebral fractures, the progression of vertebral deformities, and height loss in postmenopausal women with osteoporosis

The role of exercise in the treatment of osteoporosis

The objective of exercise in the treatment of osteoporosis is to improve axial stability through improvement of muscle strength. Therefore, a back extension exercise program specific to one's musculoskeletal competence and pain can be performed in a sitting position and later advanced to the prone position. When fragility is resolved, back extension is performed against resistance applied to the upper back. To decrease pain and immobility in acute vertebral fracture, use of spinal orthoses become inevitable. Therapeutic exercise should address osteoporosis-related deformities of axial posture, which can increase risk of fall and fracture. Strengthening of the major appendicular muscles decreases fragility. The effect of strengthening exercise is augmented by proper intake of cholecalciferol and calcium. Thus, the role of a therapeutic exercise program is to increase muscle strength safely, decrease immobility-related complications, and prevent fall and fracture. As with pharmacotherapy, therapeutic exercises are individualized

Declaration on Vitamin D in Osteoporosis Management: From the European Summit on the Role of Vitamin D in the Management of Osteoporosis: a MetaForum

On October 2005 a multidisciplinary group of delegates, which included endocrinologists, geriatricians, rheumatologists, orthopedic surgeons, gynecologists, general physicians, nurses, and patient group representatives were invited to Dublin, Ireland to draw a Consensus of the group’s opinions to form a document that would set out a call for action for professional and patient organizations. The seven lectures presented by the Faculty members included the impact of osteoporosis, the role of vitamin D both in physiology and in the prevention of fractures and falls in the elderly, the widespread prevalence of vitamin D inadequacy, and the patient and physician knowledge and attitude to vitamin D supplementation. The speakers were challenged with numerous questions by the skilled and experienced audience and a MetaForum newsletter was generated (Table I). The Declaration document encompassed action points to be accomplished and measures of success at given times. As some of the deadlines for reaching the proposed goals are approaching, it could of use to have a thought on what has been accomplished, how much needs to be done and the possible ways to hit the targets