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2018 ; 43
(2
): 92-104
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Osteoporosis: A Review of Treatment Options
#MMPMID29386866
Tu KN
; Lie JD
; Wan CKV
; Cameron M
; Austel AG
; Nguyen JK
; Van K
; Hyun D
P T
2018[Feb]; 43
(2
): 92-104
PMID29386866
show ga
Approximately 10 million men and women in the U.S. have osteoporosis,1 a
metabolic bone disease characterized by low bone density and deterioration of
bone architecture that increase the risk of fractures.2 Osteoporosis-related
fractures can increase pain, disability, nursing home placement, total health
care costs, and mortality.3 The diagnosis of osteoporosis is primarily determined
by measuring bone mineral density (BMD) using noninvasive dual-energy x-ray
absorptiometry. Osteoporosis medications include bisphosphonates, receptor
activator of nuclear factor kappa-B ligand inhibitors, estrogen
agonists/antagonists, parathyroid hormone analogues, and calcitonin.3-6 Emerging
therapies utilizing novel mechanisms include a cathepsin K inhibitor and a
monoclonal antibody against sclerostin.7,8 While professional organizations have
compiled recommendations for the management of osteoporosis in various
populations, a consensus has yet to develop as to which is the gold standard;
therefore, economic evaluations have been increasingly important to help guide
decision-makers. A review of cost-effectiveness literature on the efficacy of
oral bisphosphonates has shown alendronate and risedronate to be most
cost-effective in women with low BMD without previous fractures.9 Guidelines are
inconsistent as to the place in therapy of denosumab (Prolia, Amgen). In economic
analyses evaluating treatment of postmenopausal women, denosumab outperformed
risedronate and ibandronate; its efficacy was comparable to generic alendronate,
but it cost more.10 With regard to older men with osteoporosis, denosumab was
also found to be cost-effective when compared with bisphosphonates and
teriparatide (Forteo, Lilly).11.