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Abstract
Osteoporosis is a multifactorial progressive skeletal disorder characterized by reduced bone mass
and deterioration of bone microarchitecture. Fragility fractures, the consequence of
osteoporosis, are responsible for excess mortality, morbidity, chronic pain, admission to hospitals
and economic costs. Approximately 1.6 million hip fractures occur each year worldwide and the
incidence is set to increase to 6.3 million by 2050. Preventive measures should be started at an
early age and should include smoking cessation and weight-bearing exercises. Pharmacologic
prevention methods include calcium supplementation and administration of raloxifene or
bisphosphonates. No treatment can completely reverse established osteoporosis. Early
intervention can prevent osteoporosis in most people. For patients with established
osteoporosis, medical intervention can halt its progression. Currently available therapies include
bisphosphonates, selective estrogen receptor modulators (SERMs), hormone replacement
therapy (HRT), denosumab, teriparatide, calcitonin and strontium ranelate. Cathepsin K
inhibitors (balicatib and odanacatib) are among recent drugs under development. Saracatinib, a
novel orally available competitive inhibitor of Src kinase has been shown to inhibit bone
resorption in vitro. Lasofoxifene, bazedoxifene and arzoxifene are new SERMs in late-stage
treatment trials. Nonpharmacological measures are required when patients experience adverse
effects because of drug therapy, when symptoms are not controlled by drug therapy alone or
when patient is not willing to take drugs for a prolonged duration.
53 Kyphoplasty is a minimally
invasive spine procedure that involves the
infiltration of bone cement into a fractured vertebral
body after fracture reduction using a balloon tamp.
Indications for this procedure include relatively
acute, painful compression fractures refractory to
conservative treatment. Kyphoplasty can result in
diminished pain and reduce kyphosis; multiple
studies have shown it to be an effective treatment
for painful compression fractures with sustained
improvements in back pain, back function and
quality-of-life.