Safety concerns with the long-term management of osteoporosis

Introduction: Postmenopausal osteoporosis is a chronic disease that exerts a
significant burden on both individuals and the community. Hence, there is a
requirement for long-term treatment to be associated with a positive
benefit-risk balance.
Areas covered: In this descriptive review, the long-term safety of calcitonin,
selective estrogen receptor modulators (SERMs), bisphosphonates, denosumab
and strontium ranelate was reviewed based on randomized controlled
trials of 3 years or longer supplemented by extension study data and data
from large, observational studies.
Expert opinion: Rare adverse events become apparent with all currently available
treatments for osteoporosis with long-term therapy. Due to the rarity of
these adverse events and to the worldwide burden of osteoporosis, the benefit-
risk balance remains in favor of the beneficial effects of treatment on an
outcome rather than the probability of an adverse effect. No single antiosteoporosis
agent is appropriate for all patients. Treatment decisions should be
made on an individual basis, taking into account the relative benefits and
risks in different patient populations.