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Approaches to the Treatment of Osteoporosis
The Female Patient, 06/10/09

Pinkerton JV et al. - Early diagnosis and prevention of osteoporosis can prevent fractures. Choice of therapy depends on individual risk factors, tolerability, cost, and effectiveness of the therapy. Estrogen may be considered first-line therapy for the prevention of osteoporosis in prematurely menopausal women younger than age 50, as well as for women younger than age 60 and within 10 years of menopause with menopausal symptoms and bone loss. SERM treatment with raloxifene has shown vertebral fracture risk reduction and prevention of breast cancer. Oral and IV bisphosphonates have RCT data showing risk reductions in both vertebral and, in some, non-vertebral fractures. Anabolic therapy with PTH shows reduction in vertebral and non-vertebral fracture and is reserved for women at particularly high-risk for future fracture. Nasal calcitonin shows reductions in vertebral fracture in women more than 5 years postmenopause. Combination therapy is reserved for treatment failures when compliance has been assured, recognizing lack of fracture efficacy or long-term safety data.

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