Feature Article

Timing of therapy in osteoporosis: does it matter?

Feature Article

Timing of therapy in osteoporosis: does it matter?

ISOBELLE SMITH, JOHN A. EISMAN, KIERNAN HUGHES

Figures

© christy krames
© christy krames

Abstract

Osteoporosis is a common condition encountered in general practice and is significantly undertreated. Tailoring the type and timing of treatment to the individual patient is important to improve outcomes and minimise potential side effects. Many patients with osteoporosis will need indefinite treatment. Lower-risk patients who respond well to treatment may be considered for a break from treatment after five to 10 years of therapy.

Key Points

  • Osteoporosis causes significant morbidity and mortality but is markedly undertreated in Australia.
  • All patients who have a minimal trauma hip or vertebral fracture should receive osteoporosis therapy.
  • Treatment should be considered in patients with other minimal trauma fractures or with osteoporosis diagnosed by bone mineral density who have not yet fractured.
  • Bisphosphonates, denosumab and hormonal therapies are effective in decreasing hip, vertebral and nonvertebral fractures.
  • First-line treatment selection depends on individual patient factors and preferences.
  • Breaks from drug therapy decrease the risk of rare side effects and can be considered after 5 to 10 years of continuous treatment in patients who have not had further fractures if their T-score improves to above −2.5.
  • Cessation of denosumab results in rapid loss of bone mineral density and patients should transition to bisphosphonates for one to two years after its cessation.