Current Recommendations for the Treatment of Osteoporosis

Author:  Temelkova N.1,Popivanov P,1

1 UMBAL “Alexandrovska”, Sofia


Osteoporosis is a serious chronic disease with a high and increasing incidence, great personal burden and social significance. Low awareness of the problem, late diagnosis, inaccurate follow-up and incompetent treatment are a small part of the many problems that accompany the control of this disease. The purpose of this presentation is to analyze the current recommendations for the treatment of osteoporosis in France, Great Britain and the United States. We make a comparison in terms of fracture risk assessment, indications for starting treatment, medications of choice, duration of therapy and comprehensive care – calcium and vitamin D balance, appropriate diet and exercise program, prevention of falls. Material and methods: For this purpose, we analyzed the official documents of the National Osteoporosis Group of Great Britain, French recommendations for the management of postmenopausal osteoporosis, as well as after castration for carcinomas, the American Association of Clinical Endocrinologists, the American College of Physicians, the American College of Obstetricians and Gynecologists. We also discuss the findings of leading organizations and specialists regarding nutrition and bone health. Results: Osteoporosis treatment was based on fracture risk assessment. Differences exist regarding the T-score threshold and risk stratification. The recommendations in Europe are similar and the choice of first-line treatment is based on effectiveness, cost/effect, side effects – these are the bisphosphonates. Anabolic drugs are the drug of choice in cases of two or more vertebral fractures. This therapy, as well as treatment with Denosumab, requires mandatory follow-up treatment with bisphosphonates for a varying period – a minimum of 6 to 12 months or longer. Emphasis is on the periodic reassessment of risk, determining the duration of treatment. In conclusion, we dwell on the practice in Bulgaria regarding screening, diagnosis and treatment of patients with osteoporosis, with an analysis of the obstacles that impair treatment. The poor quality of DXA studies is a reason for unjustified treatment or its change. Another significant problem is the duration of therapy and the sequence of medications used, as well as the lack of a therapeutic plan for patients with fractures. It is necessary to completely raise the level of care for patients with osteoporosis from early accurate diagnosis to complex and sufficient treatment of the disease and adequate follow-up.

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Endocrinologia bg-flag

Journal of the Bulgarian Society of Endocrinology

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