[Indications and limitations of non-hormonal treatments of osteoporosis].

Postmenopausal osteoporosis is a multifactorial disease stemming from the accumulation of several risk factors, among which estrogen deficiency plays a key role. Although the only currently available preventive treatment is replacement estrogen and progesterone therapy, there is evidence suggesting that calcium influences cortical bone loss. In contrast, calcium alone has no effect on trabecular bone loss. Calcitonin, biphosphonates and fluoride salts are not indicated for primary prevention, in patients with no fractures. Ongoing studies are evaluating the efficacy of intranasal calcitonin and of biphosphonates for the prevention of postmenopausal osteoporosis. In the future, these specific treatments will be indicated only in women at high risk for osteoporosis. Curative therapy of patients with trabecular osteoporosis responsible for vertebral crush fractures rests on fluoride salts, calcitonin and etidronate. Fluoride is the only compound capable of inducing a substantial rise in bone mass. Some studies, but not all, suggest that fluoride treatment reduces the fracture risk. Determining the effective dosage is essential. Calcitonin is used in France in sequential treatment. Although sequentially administered calcitonin may increase bone mass, there is no other evidence that this drug reduces the fracture risk. Disodium etidronate given sequentially has recently been approved for use in osteoporosis because of data demonstrating that it decreases the incidence of new fractures over a two-year period.