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[Prevention of osteoporotic fracture by pharmaceutical interventions].

Osteoporosis has been successfully treated with anti-resorptive agents. Estrogen, ever regarded as the gold standard in the treatment of osteoporosis, has now been considered as one of the second line agents. Calcium and vitamin D still remain useful as important basic nutrients, given in combination with anti-resorptive treatments. Nitrogen containing bisphosphonates such as alendronate and risedronate and raloxifene have become the standard therapeutic agents in Japan, but their efficacies in prevention of vertebral and non-vertebral fractures are not completely similar. It has been established that BMD increase is not the primary factor on the prevention of vertebral fracture, but BMD increases seem to be critical to reduce the risk of non-vertebral fractures by anti-resorptive agents. Efficacy of combination of anti-resorptive agents with different action mechanisms such as bisphosphonates and raloxifene has not yet been established whether the combination further reduces the risk of non-vertebral fractures.