[The effect of different "coherent"-type therapeutic plans on bone mineral density and on the incidence of vertebral fractures in advanced osteoporosis].

Fifty patients with advanced osteoporosis were treated for 2 years with calcitonin+fluoride using cyclic therapeutic regimens. We evaluated their efficacy in recovering bone loss and reducing the rate of vertebral crush fractures. Twenty-seven control patients were treated for one year with calcium+vitamin D supplements. In the 59% of patients who responded to calcitonin the gain in bone mass (dual photon absorptiometry) correlated inversely with urine calcium and hydroxyproline excretion and serum osteocalcin. In the 70% responding to calcitonin+fluoride it correlated positively with serum osteocalcin and alkaline phosphatase and inversely with urine calcium and hydroxyproline excretion. Compared to basal value both coherent regimens resulted in a significant increase (calcitonin: 1.92 +/- 1.8%, p < 0.01; calcitonin+fluoride: 3.7 +/- 1.4%, p < 0.0005) in spinal bone mass but no significant differences emerged between them. The rate of vertebral crush fractures (radiogrammetry) did not very significantly in any group. The gain in bone mass does not predict the risk of vertebral crush fractures.