TREATMENT OF BONE IN ELDERLY SUBJECTS - CALCIUM, VITAMIN-D, FLOOR, BISPHOSPHONATES, CALCITONIN

Several approaches may be suggested for prevention or treatment of sen ile osteoporosis. In elderly patients, an association of calcium and v itamin D supplementation has been shown to reduce nonvertebral fractur es up to 40% over an landmonth period. Calcitonin, given parenterally or nasally, may prevent further bone loss and has been reported to sig nificantly decrease vertebral and hip fractures. This hormone also pos sesses an important analgesic effect. Fluoride salts are the most effe ctive way to significantly increase bone mass, mainly at the trabecula r site. The optimal doses and regimens remain to be clearly establishe d. The use of new formulations like sodium monofluorophosphate are lik ely to facilitate the search of the optimal therapeutic window. Bispho sphonates are potent inhibitors of bone resorption. They have been sho wn to significantly increase trabecular bone mass without impairment o f cortical bone. Their use may be associated with a significant decrea se in vertebral fractures, mainly in patients with severe osteoporosis . The new, second and third generation of bisphosphonates (tiludronate , risedronate, alendronate) look extremely promising but their widespr ead use will only be possible after a confirmation of the absence of a deleterious effect on bone quality (alendronate) and after demonstrat ion of a reduction in vertebral and/or hip fractures following a prolo nged use.