Skip to main content

Advertisement

SpringerLink
Log in

Medical treatment of vertebral osteoporosis

  • Review
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Although osteoporosis is a systemic disease, vertebral fractures due to spinal bone loss are a frequent, sometimes early and often neglected complication of the disease, generally associated with considerable disability and pain. As osteoporotic vertebral fractures are an important predictor of future fracture risk, including at the hip, medical management is targeted at reducing fracture risk. A literature search for randomized, double-blind, prospective, controlled clinical studies addressing medical treatment possibilities of vertebral fractures in postmenopausal Caucasian women was performed on the leading medical databases. For each publication, the number of patients with at least one new vertebral fracture and the number of randomized patients by treatment arm was retrieved. The relative risk (RR) and the number needed to treat (NNT, i.e. the number of patients to be treated to avoid one radiological vertebral fracture over the duration of the study), together with the respective 95% confidence intervals (95%CI) were calculated for each study. Treatment of steroid-induced osteoporosis and treatment of osteoporosis in men were reviewed separately, based on the low number of publications available. Forty-five publications matched with the search criteria, allowing for analysis of 15 different substances tested regarding their anti-fracture efficacy at the vertebral level. Bisphosphonates, mainly alendronate and risedronate, were reported to have consistently reduced the risk of a vertebral fracture over up to 50 months of treatment in four (alendronate) and two (risedronate) publications. Raloxifene reduced vertebral fracture risk in one study over 36 months, which was confirmed by 48 months' follow-up data. Parathormone (PTH) showed a drastic reduction in vertebral fracture risk in early studies, while calcitonin may also be a treatment option to reduce fracture risk. For other substances published data are conflicting (calcitriol, fluoride) or insufficient to conclude about efficacy (calcium, clodronate, etidronate, hormone replacement therapy, pamidronate, strontium, tiludronate, vitamin D). The low NNTs for the leading substances (ranges: 15–64 for alendronate, 8–26 for risedronate, 23 for calcitonin and 28–31 for raloxifene) confirm that effective and efficient drug interventions for treatment and prevention of osteoporotic vertebral fractures are available. Bisphosphonates have demonstrated similar efficacy in treatment and prevention of steroid-induced and male osteoporosis as in postmenopausal osteoporosis. The selection of the appropriate drug for treatment of vertebral osteoporosis from among a bisphosphonate (alendronate or risedronate), PTH, calcitonin or raloxifene will mainly depend on the efficacy, tolerability and safety profile, together with the patient's willingness to comply with a long-term treatment. Although reduction of vertebral fracture risk is an important criterion for decision making, drugs with proven additional fracture risk reduction at all clinically relevant sites (especially at the hip) should be the preferred options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Adachi JD, Bensen WG, Brown J, et al (1997) Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med 337:382–387

    CAS  PubMed  Google Scholar 

  2. Adachi JD, Saag KG, Delmas PD, et al (2001) Two-year effects of alendronate on bone mineral density and vertebral fracture in patients receiving glucocorticoids. Arthritis Rheum 44:202–211

    Article  CAS  PubMed  Google Scholar 

  3. Adinoff AD, Hollister JR (1983) Steroid-induced fractures and bone loss in patients with asthma. New Engl J Med 309:265–268

    CAS  PubMed  Google Scholar 

  4. Adler RA, Rosen CJ (1994) Glucocorticoids and osteoporosis. Endocrinol Metab Clin North Am 23:641–654

    CAS  PubMed  Google Scholar 

  5. Alexandersen P, Riis BJ, Christiansen C (1999) Monofluorophosphate combined with hormone replacement therapy induces a synergistic effect on bone mass by dissociating bone formation and resorption in postmenopausal women: a randomized study. J Clin Endocrinol Metab 84:3013–3020

    CAS  PubMed  Google Scholar 

  6. Alexandersen P, Toussaint A, Christiansen C, Devogelaer P, et al (2001) Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA 285:1482–1488

    Article  CAS  PubMed  Google Scholar 

  7. Aloia JF, Vaswani A, Yeh JK, Ellis K, et al (1988) Calcitriol in the treatment of postmenopausal osteoporosis. Am J Med 84:401–408

    CAS  PubMed  Google Scholar 

  8. Amin S, Lavalley M, Simms RW, Felson DT (2002) The comparative efficacy of drug therapies used for the management of corticosteroid-induced osteoporosis: a meta-regression. J Bone Miner Res 17:1512–1526

    CAS  PubMed  Google Scholar 

  9. Black DM, Palermo L, Nevitt MC, et al (1995) Comparison of methods for defining prevalent vertebral deformities: the study of osteoporotic fractures. J Bone Miner Res 10:890–902

    CAS  PubMed  Google Scholar 

  10. Black DM, Cummings SR, Karpf DB, Cauley JA, et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541

    CAS  PubMed  Google Scholar 

  11. Black DM, Thompson D, Bauer DC, Ensrud K, et al (2000) Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metab 85:4118–4124

    CAS  PubMed  Google Scholar 

  12. Blau LA, Hoehns JD (2003) Analgesic efficacy of calcitonin for vertebral fracture pain. Ann Pharmacother 37:564–570

    Article  CAS  PubMed  Google Scholar 

  13. Bombardier C, Laine L, Reicin A, et al — VIGOR Study Group (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med 343:1520–1528

    Google Scholar 

  14. Bone HG (2001) Development and evaluation of new drugs for osteoporosis. Osteoporosis (Second Edition) 2:533–538

  15. Bone HG, Downs RW, Tucci JR Harris ST, et al (1997) Dose-response relationships for alendronate treatment in osteoporotic elderly women. J Clin Endocrinol Metab 82:265–274

    CAS  PubMed  Google Scholar 

  16. Brumsen C, Papapoulos SE, Lips P, Geelhoed-Duijvestijn P, et al (2002) Daily oral pamidronate in women and men with osteoporosis: a 3-year randomized placebo-controlled clinical trial with a 2-year open extension. J Bone Miner Res 17:1057−1064

    CAS  PubMed  Google Scholar 

  17. Burger H, Van Daele PL, Algra D, et al (1994) Vertebral deformities as predictors of non-vertebral fractures. BMJ 309:991–992

    CAS  PubMed  Google Scholar 

  18. Canalis E (2003) Mechanisms of glucocorticoid-induced osteoporosis. Curr Opin Rheumatol 15:454–457

    Article  CAS  PubMed  Google Scholar 

  19. Cauley JA, Black DM, Barrett-Connor E, Harris F, et al (2001) Effects of hormone replacement therapy on clinical fractures and height loss: the Heart and Estrogen/Progestin Replacement Study (HERS). Am J Med 110:442–450

    Article  CAS  PubMed  Google Scholar 

  20. Chesnut CH, Silverman S, Andriano K, Genant H, et al (2000) A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence Of Osteoporotic Fractures study. Am J Med 109:267–276

    Article  CAS  PubMed  Google Scholar 

  21. Chevalley T, Rizzoli R, Nydegger V, Slosman D, et al (1994) Effects of calcium supplements on femoral bone mineral density and vertebral fracture rate in vitamin-D-replete elderly patients. Osteoporos Int 4:245–252

    CAS  PubMed  Google Scholar 

  22. Clemmesen B, Ravn P, Zegels B, Taquet AN, et al (1997) A 2-year phase II study with 1-year of follow-up of risedronate (NE-58095) in postmenopausal osteoporosis. Osteoporos Int 7:488–495

    CAS  PubMed  Google Scholar 

  23. Cohen S, Levy RM, Keller M, Boling E, et al (1999) Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum 42:2309–2318

    Article  CAS  PubMed  Google Scholar 

  24. Consensus Development Conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650

    PubMed  Google Scholar 

  25. Cranney A, Welch V, Adachi JD, Homik J, et al (2000) Calcitonin for the treatment and prevention of corticosteroid-induced osteoporosis. Cochrane Database Syst Rev 2:1983

    Google Scholar 

  26. Cummings SR, Nevitt MC, Browning WR, et al (1995) Risk factors for hip fracture in white women. N Engl J Med 322:767–773

    Article  Google Scholar 

  27. Cummings SR, Black DM, Thompson DE, Applegate WB, et al (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082

    CAS  PubMed  Google Scholar 

  28. Delmas PD, Ensrud KE, Adachi JD, Harper KD, et al (2002) Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 87:3609–3617

    Google Scholar 

  29. Dursun N, Dursun E, Yalcin S (2001) Comparison of alendronate, calcitonin and calcium treatments in postmenopausal osteoporosis. Int J Clin Pract 55:505–509

    CAS  PubMed  Google Scholar 

  30. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645

    CAS  PubMed  Google Scholar 

  31. Falch JA, Odegaard OR, Finnanger AM, Matheson I (1987) Postmenopausal osteoporosis: no effect of three years treatment with 1, 25-dihydroxycholecalciferol. Acta Med Scand 221:199–204

    CAS  PubMed  Google Scholar 

  32. Fogelman I, Ribot C, Smith R, Ethgen D, et al (2000) Risedronate reverses bone loss in postmenopausal women with low bone mass: results from a multinational, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 85:1895–1900

    CAS  PubMed  Google Scholar 

  33. Gallagher JC, Goldgar D (1990) Treatment of postmenopausal osteoporosis with high doses of synthetic calcitriol. A randomized controlled study. Ann Intern Med 113:649–655

    CAS  PubMed  Google Scholar 

  34. Gallagher JC, Riggs BL, Recker RR, Goldgar D (1989) The effect of calcitriol on patients with postmenopausal osteoporosis with special reference to fracture frequency. Proc Soc Exp Biol Med 191:287–292

    CAS  PubMed  Google Scholar 

  35. Greenspan S, Myers E, Maitland L, et aI (1994) Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 271:128–133

    CAS  PubMed  Google Scholar 

  36. Gutteridge DH, Stewart GO, Prince RL, Price RI et al. (2002) A randomized trial of sodium fluoride (60 mg) ± estrogen in postmenopausal osteoporotic vertebral fractures: increased vertebral fractures and peripheral bone loss with sodium fluoride; concurrent estrogen prevents peripheral loss, but not vertebral fractures. Osteoporos Int 13:158–170

    Article  Google Scholar 

  37. Harris ST, Watts NB, Jackson RD, Genant HK, et al (1993) Four-year study of intermittent cyclic etidronate treatment of postmenopausal osteoporosis: three years of blinded therapy followed by one year of open therapy. Am J Med 95:557–567

    CAS  PubMed  Google Scholar 

  38. Harris ST, Watts NB, Genant HK, McKeever CD, et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 282:1344–1352

    CAS  PubMed  Google Scholar 

  39. Häuselmann HJ, Rizzoli R (2003) A comprehensive review of treatments for postmenopausal osteoporosis. Osteoporos Int 14:2–12

    PubMed  Google Scholar 

  40. Heikki Frick M, Elo O, Haapa A, et al (1987) Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors and incidence of coronary heart disease. New Engl J Med 317:1237–1245

    PubMed  Google Scholar 

  41. Hizmetli S, Elden H, Kaptanoglu E, Nacitarhan V, et al (1998) The effect of different doses of calcitonin on bone mineral density and fracture risk in postmenopausal osteoporosis. Int J Clin Pract 52:453–455

    CAS  PubMed  Google Scholar 

  42. Hulley S, Grady D, Bush T, Furberg C, et al (1998) Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 280:605–613

    CAS  PubMed  Google Scholar 

  43. Hulley S, Furberg C, Barrett-Connor E, Cauley J, et al (2002) Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 288:58–66

    CAS  PubMed  Google Scholar 

  44. Jalava T, Sarna S, Pylkkanen L, et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260

    PubMed  Google Scholar 

  45. Kanis JA, Brazier JE, Stevenson M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technology Assessment 6(29)

    Google Scholar 

  46. Kleerekoper M, Peterson EL, Nelson DA, Phillips E, et al (1991) A randomized trial of sodium fluoride as a treatment for postmenopausal osteoporosis. Osteoporos Int 1:155–161

    CAS  PubMed  Google Scholar 

  47. Lafague-Proust MH, Boudignon B, Thierry T (2003) Glucocorticoid-induced osteoporosis: pathophysiological data and recent treatments. Joint Bone Spine 70:109–118

    Article  PubMed  Google Scholar 

  48. Lane NE, Sanchez S, Modin GW, Genant HK, Pierini E, Arnaud CD (1998) Parathyroid hormone treatment can reverse corticosteroid-induced osteoporosis. J Clin Invest 102:1627–1633

    CAS  PubMed  Google Scholar 

  49. Levis S, Quandt SA, Thompson D, Scott J, et al (2002) Alendronate reduces the risk of multiple symptomatic fractures: results from the fracture intervention trial. J Am Geriatr Soc 50:409–415

    Article  PubMed  Google Scholar 

  50. Liberman UA, Weiss SR, Bröll J, Minne HW, et al (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 333:1437–1443

    CAS  PubMed  Google Scholar 

  51. Lindsay R, Nieves J, Formica C, Henneman E, et al (1997) Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet 350:550–555

    CAS  PubMed  Google Scholar 

  52. Luengo M, Picado C, Dei Rio L, et al (1991) Vertebral fractures in patients with rheumatoid arthritis treated with corticosteroids. Thorax 46:803–806

    CAS  PubMed  Google Scholar 

  53. Lufkin EG, Wahner HW, O'Fallon WM, Hodgson SF, et al (1992) Treatment of postmenopausal osteoporosis with transdermal estrogen. Ann Intern Med 117:1–9

    CAS  PubMed  Google Scholar 

  54. Lyritis GP, Tsakalakos N, Papspati I, Skarantavos G, et al (1997) The effect of a modified etidronate cyclical regimen on postmenopausal osteoporosis: a four-year study. Clin Rheumatol 16:354–360

    CAS  PubMed  Google Scholar 

  55. McCloskey E, Selby P, De Takats D, Bernard J, et al (2001) Effects of clodronate on vertebral fracture risk in osteoporosis: a 1-year interim analysis. Bone 28:310–315

    Article  CAS  PubMed  Google Scholar 

  56. McClung MR, Geusens P, Miller PD, Zippel H, et al (2001) Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 344:333–340

    Article  CAS  PubMed  Google Scholar 

  57. McKeogh DF (2003) Celecoxib versus diclofenac and omeprazole to prevent recurrent ulcer bleeding. N Engl J Med 348:2464–2466

    Article  Google Scholar 

  58. Melton LJ, Kan SH, Frye MA, et al (1989) Epidemiology of vertebral fractures in women. Am J EpidemioI 129:1000–1011

    Google Scholar 

  59. Meunier PJ, Slosman DO, Delmas PD, Sebert JL, et al (2002) Strontium ranelate: dose-dependent effects in established postmenopausal vertebral osteoporosis—a 2-year randomized placebo-controlled trial. J Clin Endocrinol Metab 87:2060–2066

    Google Scholar 

  60. Naganathan V, Jones G, Nash P, et al (2000) Vertebral fracture risk with long-term corticosteroid therapy. Arch Intern Med 160:2917–2922

    Article  CAS  PubMed  Google Scholar 

  61. Neer RM, Arnaud CD, Zanchetta JR, Prince R, et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441

    CAS  PubMed  Google Scholar 

  62. Neuner JM, Zimmer, JK, Hamel MB (2003) Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures. J Am Geriatr Soc 51:483–491

    PubMed  Google Scholar 

  63. Nevitt MC, Ettinger B, Black DM (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800

    CAS  PubMed  Google Scholar 

  64. Orwoll E, Ettinger M, Weiss S, et al (2000) Alendronate for the treatment of osteoporosis in men. N Engl J Med 343:604–610

    CAS  PubMed  Google Scholar 

  65. Osteoporosis Methodology Group and Osteoporosis Research Advisory Group (2002) Meta-analyses of therapies for postmenopausal osteoporosis. Endocrine Rev 23:495–578

    Google Scholar 

  66. Ott SM, Chesnut CH (1989) Calcitriol treatment is not effective in postmenopausal osteoporosis. Ann Intern Med 110:267–274

    CAS  PubMed  Google Scholar 

  67. Overgaard K, Hansen MA, Jensen SB, Christiansen C (1992) Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. BMJ 305:556–561

    CAS  PubMed  Google Scholar 

  68. Pak CY, Sakhaee K, Adams-Huet B, Piziak V, et al (1995) Treatment of postmenopausal osteoporosis with slow-release sodium fluoride. Final report of a randomized controlled trial. Ann Intern Med 123:401–408

    CAS  PubMed  Google Scholar 

  69. Recker RR, Hinders S, Davies KM, Heaney RP, et al (1996) Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res 11:1961–1966

    CAS  PubMed  Google Scholar 

  70. Recker RR, Davies KM, Dowd RM, Heaney RP (1999) The effect of low-dose continuous estrogen and progesterone therapy with calcium and vitamin D on bone in elderly women. A randomized controlled trial. Ann Intern Med 130:897–904

    CAS  PubMed  Google Scholar 

  71. Reginster JY, Meurmans L, Zegels B, Rovati LC, et al (1998) The effect of sodium monofluorophosphate plus calcium on vertebral fracture rate in postmenopausal women with moderate osteoporosis. A randomized, controlled trial. Ann Intern Med 129:1–8

    CAS  PubMed  Google Scholar 

  72. Reginster JY, Minne HW, Sorensen OH, Hooper M, et al (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 11:83–91

    CAS  PubMed  Google Scholar 

  73. Reginster JY, Christiansen C, Roux C, Fechtenbaum J, et al (2001) Intermittent cyclic tiludronate in the treatment of osteoporosis. Osteoporos Int 12:169–177

    Article  CAS  PubMed  Google Scholar 

  74. Reid DM, Hughes RA, Laan RF, et al (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European Corticosteroid-Induced Osteoporosis Treatment Study. J Bone Miner Res 15:1006–1013

    CAS  PubMed  Google Scholar 

  75. Reid DM, Adami S, Devogelaer JP, Chines AA (2001) Risedronate increases bone density and reduces vertebral fracture risk within one year in men on corticosteroid therapy, Calcif Tiss Int 69:242–247

    Google Scholar 

  76. Riggs BL, Hodgson SF, O'Fallon WM, Chao EYS, et al (1990) Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med 322:802–809

    CAS  PubMed  Google Scholar 

  77. Ringe JD, Kipshoven C, Cöster A, Umbach R (1999) Therapy of established postmenopausal osteoporosis with monofluorophosphate plus calcium: dose-related effects on bone density and fracture rate. Osteoporos Int 9:171–178

    Article  CAS  PubMed  Google Scholar 

  78. Ringe JD, Faber H, Dorst A (2001) Alendronate treatment of established primary osteoporosis in men: results of a 2-year prospective study. J Clin Endocrinol Metab 86:5252–5255

    CAS  PubMed  Google Scholar 

  79. Ross PD, Davis JW, Epstein RS, et al (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923

    CAS  PubMed  Google Scholar 

  80. Ryan PJ, Blake GM, Davie M, Haddaway M, et al (2000) Intermittent oral disodium pamidronate in established osteoporosis: A 2-year double-masked placebo-controlled study of efficacy and safety. Osteoporos lnt 11:171–176

    CAS  Google Scholar 

  81. Saag KG, Emekey R, Schnitzer TJ, et al (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 339:292–299

    Article  CAS  PubMed  Google Scholar 

  82. Sambrook PN, Kotowicz M, Hash P, et al (2003) Prevention and treatment of glucocorticoid-induced osteoporosis: a comparison of calcitriol, vitamin D plus calcium and alendronate plus calcium. J Bone Miner Res 18:919–924

    CAS  PubMed  Google Scholar 

  83. Silverstein FE, Graham DY, Senior JR, et al (1995) Misoprostol reduces serious gastro-intestinal complications in patients with rheumatoid arthritis receiving non steroidal anti-inflammatory drugs. Ann Int Med 123:241–249

    CAS  Google Scholar 

  84. Steering Committee of the Physicians' Health Study Group (1989). Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med 321:129–135

    PubMed  Google Scholar 

  85. Storm T, Thamsborg G, Steiniche T, Genant HK, et al (1990) Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. N Engl J Med 322:1265–1271

    CAS  PubMed  Google Scholar 

  86. Tilyard MW, Spears GFS, Thomson J, Dovey S, et al (1992) Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med 326:357–362

    Google Scholar 

  87. van Staa TP, Leufkens HG, Cooper C (2001) Use of inhaled corticosteroids and risk of fractures. J Bone Miner Res 16:581–588

    PubMed  Google Scholar 

  88. Wallach S, Cohen S, Reid DM, et al (2000) Effects of risedronate treatment on bone density and vertebral fracture in patients on corticosteroid therapy. Calcif Tissue Int 67:277–285

    Article  CAS  PubMed  Google Scholar 

  89. Walsh LJ, Wong CA, Pringle M, Tattersfield AE (1996) Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross-sectional study. BMJ 313:344–346

    CAS  PubMed  Google Scholar 

  90. Watts NB, Harris ST, Genant HK, Wasnich RD, et al (1990) Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. N Engl J Med 323:73–79

    CAS  PubMed  Google Scholar 

  91. WHO study group (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report series. WHO, Geneva

  92. Wimalawansa SJ (1998) A four-year randomized controlled trial of hormone replacement and bisphosphonate, alone or in combination, in women with postmenopausal osteoporosis. Am J Med 104:219–226

    CAS  PubMed  Google Scholar 

  93. Windeler J, Lange S (1995) Events per person year, a dubious concept. BMJ 310:454–456

    CAS  PubMed  Google Scholar 

  94. Wong CA, Walsh LJ, Smith CJP, et al (2000) Inhaled corticosteroid use and bone mineral density in patients with asthma. Lancet 355:1399–1403

    PubMed  Google Scholar 

  95. Writing Group for the Women's Health Initiative Investigators (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 288:321–333

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Osteoporosis Policlinic, University Hospital of Berne, 3010, Berne, Switzerland

    K. Lippuner

Authors
  1. K. Lippuner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Lippuner.

Additional information

The author has no conflict of interest

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lippuner, K. Medical treatment of vertebral osteoporosis. Eur Spine J 12 (Suppl 2), S132–S141 (2003). https://doi.org/10.1007/s00586-003-0608-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-003-0608-x

Keywords

Search

Navigation