Abstract
Osteoporosis, as a chronic condition, is considered a major health and socio-economic problem. With the increasing mean age and aging population, the issue starts to affect also males and countries with less developed economies as well as social welfare and healthcare systems.
Osteoporotic fractures considerably reduce patients' mobility, self-care and self-sufficiency during their recovery and long after. To prevent them effectively, detailed knowledge is necessary of the anatomy and structural geometry of the areas where bone strength is most frequently impaired.
Given the fact that cortical bone accounts for 80 % of bone strength, pharmacological therapy proven to influence cortical bone porosity and strength needs to be selected. New imaging methods allow identification of the so-called locus minoris resistentiae and, at the same time, verify the actual effect on bone strength, or its resistance to stress.
The authors discuss the impact of bisphosphonates and raloxifene on trabecular and cortical bone, and present results of osteoanabolic therapy with teriparatide able to revert cortical bone thinning. The newer drug denosumab has been shown to increase cortical BMD and sclerostin antibodies positively regulate bone formation and improve response to bone stress.
Apart from common imaging methods, densitometry offers hip structure analysis (HSA) and trabecular bone score (TBS) able to assess the area of our interest and individualize the therapy.