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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 1089-1090
Osteoporosis: The present concern on available drugs in view of public health pharmacology


1 KMT Primary Care Center, Bangkok, Thailand
2 Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria

Click here for correspondence address and email

Date of Web Publication5-Oct-2017
 

How to cite this article:
Yasri S, Wiwanitkit V. Osteoporosis: The present concern on available drugs in view of public health pharmacology. Ann Trop Med Public Health 2017;10:1089-90

How to cite this URL:
Yasri S, Wiwanitkit V. Osteoporosis: The present concern on available drugs in view of public health pharmacology. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 21];10:1089-90. Available from: http://www.atmph.org/text.asp?2017/10/4/1089/196745


Dear Sir,

Osteoporosis is a big problem attacking millions of people around the world. The medication for management of these patients is an interesting topic.[1–3] Not only menopause female but also elderly males can encounter osteoporosis.[4] In public health pharmacology, the evaluation and assignment of appropriate drugs to appropriate group of patients is needed. There are many drugs for the treatment of osteoporosis. Once weekly oral dose of alendronate and risedronate can help increase bone density and decrease the risk of fracture, which is not different from once daily use but can increase the compliance of the patient.[5] A weekly oral dose of alendronate or risedronate plus vitamin D (2800 units or 5600 units per tablet) has the same efficacy as once daily dose administration of the drugs.[5] Once monthly dose of risedronate can increase the bone density and decrease the risk of bone fracture similar to once weekly use and can increase the compliance of the patient.[5] Once daily dose of ibandronate can increase the bone density and decrease the risk of vertebra fracture.[6]

The efficacy in reducing the nonvertebral fracture is evidenced from a study on the use of this drug in a patient with hip bone density T-score less than –3.0 by once monthly oral regimen, and trimonthly injection regimen can increase the bone density and decrease the risk of vertebral fracture similar to once daily regimen and can also increase the patient's compliance.[6] Strotium ranelate is another drug that can increase the bone density in males with osteoporosis and also in menopause female; hence, it is recommended as an alternative treatment for male patients with osteoporosis.[7]

The contraindication for strotium ranelate is observed in (a) patients with history or present illness due to ischemic heart disease, peripheral arterial disease, and cerebrovascular disease, (b) patients with history or present illness due to venous thromboembolism including deep vein thrombosis and pulmonary embolism, (c) patients with a history or present illness due to permanent and nonpermanent immobilization including bed-ridden status, and (d) patients with uncontrolled hypertension.[7] Denosumab is indicated for treatment of osteoporosis in menopause females with high risk of fracture.[8] It can decrease the incidence of vertebral fractures, hip fractures, and nonvertebral fractures. Hence, it mainly used for the treatment of osteoporosis in menopause females.[8] There is strong evidence that this drug can add up the bone density values of lumbar vertebra, hip and radius in menopause females and can increase the bone density in males with osteoporosis: hence, this drug is recommended for both menopause women and men with osteoporosis.[8] It can prevent the bone mass loss in females with breast cancer receiving aromatase inhibitor and can prevent bone mass loss in males with prostate cancer receiving androgen deprivation therapy who have high risk of fracture. It is recommended for the treatment of osteoporosis.[8] The recommendation is subcutaneous injection every 6 months and there is no requirement of decreasing the dosage in patients with impaired renal function. There is a precaution for the patients with risk of hypocalcemia.[8] There is evidence that this drug can increase the risk of skin infection and might induce skin rash and dermatitis.[8]

It is recommended to monitor these problems in any patient receiving this drug. Focusing on osteonecrosis of the jaw and atypical femoral fracture, there are lower incidences compared with bisphosphonate.[9]

Raloxifene can prevent the loss of bone mass and reduce the risk of vertebral fracture in menopause females with osteoporosis.[10] It can reduce the risk of breast cancer in females with osteoporosis.[10] The effectiveness is comparable to that of tamoxifen in the prevention of breast cancer in females in the risk group.[10] Menatetrenone is another drug that might be useful for patients with high undercaboxylated osteocalcin (ucOC) levels and can prevent the bone mass loss and reduce the risk of vertebral fracture and repeated vertebral fracture in patients with previous history of at least five sites of vertebral fractures.[11] The last drug, teriparatide (PTH 1-34), is used for intradermal injection.[12] This drug can help increase bone density and decrease the risk of vertebral fracture and nonvertebral fracture in patients with a previous history of vertebral fracture in both menopause females and elderly males.[12] Recognizing the efficacy and effectiveness of the available drugs and the reported side effects can be useful for practitioners to manage osteoporosis, which is the present worldwide public health burden.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kageyama G. The diagnosis and treatment of osteoporosis. Rinsho Byori 2015;63:570-9.  Back to cited text no. 1
[PUBMED]    
2.
Gupta A, March L. Treating osteoporosis. Aust Prescr 2016;39:40-6.  Back to cited text no. 2
[PUBMED]    
3.
Ivanova S, Vasileva L, Ivanova S, Peikova L, Obreshkova D. Osteoporosis: therapeutic options. Folia Med (Plovdiv) 2015;57:181-90.  Back to cited text no. 3
[PUBMED]    
4.
Farahmand P, Spiegel R, Ringe JD. Male osteoporosis. Z Rheumatol 2016;75:459-65.  Back to cited text no. 4
[PUBMED]    
5.
Eriksen EF, Díez-Pérez A, Boonen S. Update on long-term treatment with bisphosphonates for postmenopausal osteoporosis: a systematic review. Bone 2014;58:126-35.  Back to cited text no. 5
    
6.
Rossini M, Orsolini G, Adami S, Kunnathully V, Gatti D. Osteoporosis treatment: why ibandronic acid? Expert Opin Pharmacother 2013;14:1371-81.  Back to cited text no. 6
[PUBMED]    
7.
Marie PJ. Strontium ranelate: a novel mode of action optimizing bone formation and resorption. Osteoporos Int 2005;16:S7-10.  Back to cited text no. 7
[PUBMED]    
8.
Gu HF, Gu LJ, Wu Y, Zhao XH, Zhang Q, Xu ZR, et al. Efficacy and safety of denosumab in postmenopausal women with osteoporosis: a meta-analysis. Medicine (Baltimore) 2015;94:1.  Back to cited text no. 8
[PUBMED]    
9.
Diab DL, Watts NB. Denosumab in osteoporosis. Expert Opin Drug Saf 2014;13:247-53.  Back to cited text no. 9
[PUBMED]    
10.
Lips P, Netelenbos JC. Estrogen agonists, especially raloxifene, in the treatment of osteoporosis. Ned Tijdschr Geneeskd 1996;140:1215-7.  Back to cited text no. 10
[PUBMED]    
11.
Iwamoto J, Sato Y. Menatetrenone for the treatment of osteoporosis. Expert Opin Pharmacother 2013;14:449-58.  Back to cited text no. 11
[PUBMED]    
12.
Babu S, Sandiford NA, Vrahas M. Use of teriparatide to improve fracture healing: what is the evidence? World J Orthop 2015;6:457-61.  Back to cited text no. 12
[PUBMED]    

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Correspondence Address:
Sora Yasri
KMT Primary Care Center, Bangkok
Thailand
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.196745

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