BISPHOSPHONATES AND OSTEOPOROSIS TREATMENT IN ITALY

A treatment against osteoporosis can be considered efficacious only wh en its beneficial effects on bone remodeling, bone mass, and osteoporo tic fracture incidence are proven. As for any treatment, proven effica cy must be combined with proven safety. This review analyzes published data on efficacy and safety of alendronate, clodronate and etidronate , the bisphosphonates currently marketed in Italy for osteoporosis tre atment. Different studies have shown that alendronate, clodronate and etidronate reduce bone turnover, and increase bone mineral density in postmenopausal osteoporotic patients. Prospective, double blind, multi center studies reported a reduction in osteoporotic fracture incidence for alendronate and etidronate. Fracture incidence reduction by clodr onate, on the other hand, was shown only in an open label study. Final ly, a reduction in fracture incidence by etidronate was shown in a lar ge retrospective postmarketing study. Postmarketirrg surveillance evid enced that osteomalacia, a suspected side effect of etidronate treatme nt, does not occur at the currently used dose regimens. Postmarketing surveillance of alendronate has recently raised some concern regarding possible severe esophageal damage during alendronate treatment, espec ially when the drug is not taken according to the manufacturer's instr uctions. (Aging Clin. Exp. Res. 10: 284-294, 1998) (C) 1998, Editrice Kurtis.