Rheumatology 2000; 39: 1309-1312
© 2000 British Society for Rheumatology
Editorials |
Pharmacological interventions for post-menopausal osteoporosis: an evidence-based approach
Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
| The first 150 words of the full text of this article appear below. |
Fragility fracture is the hallmark of osteoporosis and its only significant clinical manifestation. The primary aim of intervention is therefore to reduce the risk of fracture, and demonstration of this effect is required before efficacy can be regarded as proven. Increases in bone mineral density cannot be used as a surrogate for fracture reduction because the relationship between these two outcomes is not always predictable either in direction or magnitude. The evidence-based approach thus requires proof of efficacy from adequately powered randomized controlled trials in which fracture is the primary end-point.
In recent years there have been significant advansces in the management of post-menopausal osteoporosis and a range of pharmacological options are now available. Largely for historical reasons, the level of evidence on which the registration of these agents is based varies widely. For hormone replacement therapy, evidence for anti-fracture efficacy is based mainly on observational data; because of the
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