Rd. Blank et Rs. Bockman, A review of clinical trials of therapies for osteoporosis using fracture as an end point, J CLIN DENS, 2(4), 1999, pp. 435-452
As the population ages, fragility fractures grow in importance as a public
health problem. The principal goal of osteoporosis therapy is primary and s
econdary fracture prevention. A growing choice of therapies is now availabl
e for the treatment of osteoporosis. In this article, we review their effic
acy using fracture prevention as an end point. The considerable heterogenei
ty among studies with regard to patient age, past fracture history, fractur
e site, and analytical methods precludes the possibility of performing a me
aningful meta-analysis. Fracture outcomes have been reported in clinical tr
ials with calcium supplementation, vitamin D supplementation, estrogen repl
acement therapy (ERT), calcitonin, etidronate, alendronate, sodium fluoride
(NaF), parathyroid hormone (PTH), and raloxifene. Compelling evidence for
fracture prevention has been provided for calcium and vitamin D supplementa
tion and alendronate treatment. Evidence of fracture prevention exists for
ERT, raloxifene, calcitonin, etidronate, and PTH. Data on NaF are inconsist
ent. Across agents, there is a trend toward greater efficacy for patients a
t greatest risk of fracture.