Current therapeutic approaches to
postmenopausal bone loss or established
osteoporosis vary widely among the different regions of the world. Because no treatment of
osteoporosis has unequivocally demonstrated full prevention of the appearance or the recurrence of axial or peripheral fractures so far, many investigational compounds are being developed.
Anabolic steroids act mainly as inhibitors of
bone resorption with very few, if any, effects on bone formation. Because of the high occurrence of signs of
virilization and the weak effects on bone structure, the risk/benefit ratio in
osteoporosis should be considered at least problematic. If ongoing large-scale trials confirm the expected benefits of
estrogen antagonist/agonists on the skeleton and confirm no cardiovascular risk to postmenopausal women with optimal uterine safety, these substances are likely to become the most prominent alternative to hormonal replacement
therapy after the menopause. Additional studies are requested to evaluate the potential benefit of
growth hormone or
insulin-like growth factors in treatment of
osteoporosis.
Ipriflavone acts predominantly as an inhibitor of
bone resorption. To confirm the efficacy of
ipriflavone on the prevention of vertebral fractures and its effects on bone mineral density in women with postmenopausal established
osteoporosis, a large multicentric European study is being conducted. Treatment with parathyroid
peptides induces a significant gain in bone mass, mainly in the axial skeleton. Long-term studies that compare
peptides, doses, and regimes are needed to better understand the exact position of parathyroid
peptides as treatment of
osteoporosis. Prolonged administration of
strontium to postmenopausal osteoporotic women resulted in a decoupling between
bone resorption and formation that yielded a significant increase in the lumbar spine bone mineral density of treated subjects. In the view of these promising results and of the excellent tolerance of
strontium during preliminary trials, additional investigations of this compound in prevention and treatment of
osteoporosis should be promptly initiated. Several other compounds have been punctually suggested for treatment of
osteoporosis or are at very early stages of development. Finally, besides pharmacologic approaches to the treatment of
osteoporosis,
hip fractures may also be reduced by the use of hip protectors.