ABSTRACT
Introduction At present, we have the option o f treating high-risk patients with several drugs with good fracture reduction in randomized controlled trials. These include bisphos phonates, selective (o)estrogen receptor modulators (SERMs) and parathyroid hormone (PTH). In the future, there will probably be additional drugs such as strontium, receptor activator o f nuclear kappa B ligand, other SERMs, etc. Trials show that we can offer various treatments to patients according to their risk profile. One important point is that the design o f the trial (mainly the inclusion criteria) can limit the use o f the drug. For example, bisphosphonates have mainly been used in patients with a prior fracture and/or low bone mass. SERM trials have used the same inclusion criteria, as have those with PTH, whereas oestrogen was used in the general population in the Women’s Health Initiative trial. Calcium and vitamin D supple mentation is also effective in the general population, mainly in the elderly residing in nursing homes. For bisphosphonates and SERMs, selection for risk factors other than bone mineral density (BMD) and prior fracture has shown consistent fracture reduction, within the limits o f the studies.
