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Advances in the
treatment of
osteoporosis
British Medical Bulletin
Take-home message
•
The authors performed a review of current evidence on existing
treatments and novel therapies for osteoporosis, and they discuss the
challenge of becoming familiar with treatment agents which are not yet
readily available.
•
Research is required to clarify the optimal duration of therapy, the use of
new therapies in combination, and the ordering of available therapies.
Abstract
INTRODUCTION
Osteoporosis is a significant public health issue affecting over half of
women aged over 50. With an aging population, its importance is set to increase fur-
ther over time. Prevention of fragility fractures avoids significant mortality and morbidity
as well as saving significant direct and indirect costs to the economy. In this review,
we discuss existing treatments to contextualize the treatment landscape, and demon-
strate how our understanding of bone pathophysiology has led to novel therapies-in
the form of combinations and altered durations of existing treatments, as well as newer
drug therapies.
SOURCES OF DATA
PubMed and Embase were searched for randomized controlled trials
of new therapies for osteoporosis. These searches were supplemented with material
presented in abstract form at international meetings.
AREAS OF AGREEMENT
New drugs that appear promising in the treatment of osteoporosis
include the cathepsin K inhibitor, monoclonal antibodies against sclerostin and parathy-
roid hormone-related protein analog.
AREAS OF CONTROVERSY
Separate to the development of novel drug therapies is the issue
of how best to use agents that are currently available to us; specifically which agent to
choose, alone or in combination; duration of therapy; how best to identify patients at
highest risk of fracture, and to ensure the highest possible adherence to medication.
Many of these issues have been addressed in other excellent review papers, and will
not be considered in detail here.
GROWING POINTS
As with all new treatments, we await results of long-term use and expe-
rience in ‘real life’ patient populations.
AREAS TIMELY FOR DEVELOPING RESEARCH
As alluded to above, data are urgently required
regarding the optimal duration of therapy; use of combination therapy; ordering of
therapies for best therapeutic effect. As stratified medicine becomes more strongly
considered in all areas of therapy, its merits in osteoporosis as in other musculoskele-
tal conditions, is timely and valuable.
Novel advances in the treatment of osteoporosis.
Br Med Bull
2016 Sep 01;119(1)129-
42, CK Chan, A Mason, C Cooper, E Dennison.
Balneotherapy
for pain relief,
stiffness, and
physical function
in osteoarthritis
of the knee
Clinical Rheumatology
Take-home message
•
The effectiveness of balneotherapy for
knee osteoarthritis was evaluated in
this meta-analysis of eight clinical trials,
including 359 cases and 375 controls. Bal-
neotherapy improved pain, stiffness, and
function, although there was high hetero-
geneity (88–93%).
•
Balneotherapy may be beneficial in osteo-
arthritis of the knee; however, the authors
suggest that the observed heterogeneity
was a result of the quality of the trials
included.
Abstract
This meta-analysis was performed to determine the
effect of balneotherapy on relieving pain and stiffness
and improving physical function, compared to controls,
among patients with knee osteoarthritis. We searched
electronic databases for eligible studies published from
2004 to December 31, 2016, with language restrictions
of English or Japanese. We screened publications in
Medline, Embase, Cochrane library, and the Japan Med-
ical Abstracts Society Database using two approaches,
MeSH terms and free words. Studies that examined
the effect of balneotherapy for treating knee osteoar-
thritis of a ≥2-week duration were included. Western
Ontario and McMaster Universities Osteoarthritis Index
(WOMAC) scores were used as the outcome measure.
A total of 102 publications were assessed according
to the exclusion criteria of the study; eight clinical trial
studies, which comprised a total of 359 cases and
375 controls, were included in this meta-analysis. The
meta-analysis analyzed improvement in WOMAC score
at the final follow-up visit, which varied from 2 to 12
months post-intervention. Our meta-analysis indicates
that balneotherapy was clinically effective in relieving
pain and stiffness, and improving function, as assessed
by WOMAC score, compared to controls. However,
there was high heterogeneity (88 to 93%). It is possible
that balneotherapy may reduce pain and stiffness, and
improve function, in individuals with knee osteoarthritis,
although the quality of current publications contributes
to the heterogeneity observed in this meta-analysis.
The effect of balneotherapy on pain relief, stiffness,
and physical function in patients with osteoarthritis of
the knee: a meta-analysis.
Clin Rheumatol
2017 Mar
16;[EPub Ahead of Print], H Matsumoto, H Hagino, K
Hayashi, et al
RHEUMATOLOGY
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PRACTICEUPDATE DERMATOLOGY