Long-term antifracture efficacy and safety of antiosteoporotic treatments: the hidden part of the iceberg

Abstract

Long-term antifracture efficacy and safety are the two major goals of any antiosteoporotic treatments. So far, several drugs have proved to be effective and safe during the 2-3 years period of controlled clinical trials but only a few of them have shown bone protection up to 5 years, which is the minimum period in order to assume there is sustained fracture reduction. Raloxifene has shown efficacy in vertebral fracture risk reduction in up to 5 years but no effect in non-vertebral fracture. Risedronate and Alendronate have also shown anti-fracture efficacy in vertebral fracture risk reduction up to 7 and 10 years respectively, but no long-term benefit was observed in non-vertebral fracture. Strontium ranelate have demonstrated a sustained fracture risk reduction up to 5 years in vertebral and non-vertebral fractures. In addition, preliminary analyses of the 8 years treatment have shown the same trend in vertebral and non-vertebral fracture risk reduction. In summary, at least 4 drugs have demonstrated a sustained vertebral antifracture efficacy but only strontium ranelate has proved to be long-term efficient in non-vertebral fracture.