Skip to main content
SpringerLink
Log in

Treatment of Postmenopausal Osteoporosis

  • Original Article
  • Published:
Comprehensive Therapy

Abstract

Osteoporosis is a skeletal disease characterized by low bone mass and microarchitectural deterioration with a resulting increase in bone fragility and hence susceptibility to fracture. Calcium and vitamin D are the most commonly used therapies for osteoporosis, although their efficacy in osteoporotic fracture prevention remains uncertain. Biphosphonates are the most frequently prescribed medication for treatment of osteoporosis and are often considered as first-line therapy for the treatment of osteoporosis. Currently, hormone replacement therapy is only approved by the Food and Drug Administration (FDA) for short-term treatment of severe postmenopausal symptoms with the lowest dose used for the shortest time. In view of its lack of effect on the prevention of nonvertebral fractures, the use of raloxifene should be limited to women with spinal osteoporosis. Most experts agree that it is preferable to treat osteoporosis with a more potent agent than calcitonin and manage the pain separately. Currently, the FDA recommends the use of parathyroid hormone for treatment of osteoporosis for a maximum of 2 years because of the concern of development of osteosarcoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis and Therapy. Osteoporosis prevention, diagnosis and therapy. JAMA 2001;285:785–95.

    Article  Google Scholar 

  • Department of Health and Human Services. Bone health and osteoporosis: a report of the Surgeon General. Rockville, MD. Office of the Surgeon General, 2004.

  • WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: technical report series 843. Geneva: WHO; 1994.

    Google Scholar 

  • Gabriel SE, Tosteson AN, Leibson CL, et al. Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 2002;13:323–30.

    Article  PubMed  CAS  Google Scholar 

  • Beaton DE. Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 2004:767–778.

  • Solomon DH, Finkelstein JS, Katz JN, et al. Underuse of osteoporosis medications in elderly patients with fractures. Am J Med 2003;115:398–400.

    Article  PubMed  Google Scholar 

  • Johnell O, Kanis JA, Black DM, et al. Associations between baseline risk factors and vertebral fracture risk in the Multiple Outcomes of Raloxifene Evaluation (MORE) Study. J Bone Miner Res 2004;19:764–72.

    Article  PubMed  CAS  Google Scholar 

  • Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761–7.

    Article  PubMed  Google Scholar 

  • Heaney RP. Remodeling and skeletal fragility. Osteoporos Int 2003;14 Suppl 5:S12–5.

    Google Scholar 

  • Currey JD. Role of collagen and other organics in the mechanical properties of bone. Osteoporos Int 2003;14 Suppl 5:S29–36.

    Google Scholar 

  • Stein E, Shane E. Secondary osteoporosis. Endocrinol Metab Clin N Am 2003;32:115–34.

    Article  Google Scholar 

  • Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporosis Int 1999;10:259–64.

    Article  CAS  Google Scholar 

  • Preventive Services Task Force. Screening for osteoporosis in postmenopausal women: recommendations and rationale. Ann Intern Med 2002;137:526–8.

    Google Scholar 

  • National Osteoporosis Foundation. Physician’s guide to prevention and treatment of osteoporosis, Washington, DC: National Osteoporosis Foundation; 2003.

    Google Scholar 

  • Picard D, Brown JP, Rosenthall L, et al. Ability of peripheral DXA measurement to diagnose osteoporosis as assessed by central DXA measurement. J Clin Densitom 2004;7:111–8.

    Article  PubMed  CAS  Google Scholar 

  • Johnell O, Oden A, De Laet C, et al. Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int 2002;13:523–6.

    Article  PubMed  CAS  Google Scholar 

  • Garnero P, Mullerman D, Munoz F. Long-term variability of markers of bone turnover in postmenopausal women and implications for their clinical use: the OFELY study. J Bone Miner Res 2003;18:1789–94.

    Article  PubMed  Google Scholar 

  • Supplement business report. San Diego, Calif.: Nutrition Business Journal, 2005: 203.

  • Chapuy M, Arlot M, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly. N Engl J Med 1992;327:1637–42.

    Article  PubMed  CAS  Google Scholar 

  • Trivedi D, Doll R, Khaw K. Effect of four monthly oral vitamin D3(cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomized double blind controlled trial. BMJ 2003;326:469–75.

    Article  PubMed  CAS  Google Scholar 

  • Grant AM, Avenell A, Campbell MK, et al. Randomised placebo-controlled trial of daily oral vitamin D3 and/or calcium for the secondary prevention of low trauma fractures in the elderly. Lancet 2005;365:1621–8.

    Article  PubMed  CAS  Google Scholar 

  • Shea B, Wells G, Cranney A, et al. Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of post-menopausal osteoporosis. Endocr Rev 2002;23:552–9.

    Article  PubMed  CAS  Google Scholar 

  • Jackson RD, LaCroix A, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006;354:669–83.

    Article  PubMed  CAS  Google Scholar 

  • Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA 2004;291:1999–2006.

    Article  PubMed  CAS  Google Scholar 

  • Cummings SR, Karpf DB, Harris F, et al. Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresoptive drugs. Am J Med 2002;112:281–9.

    Article  PubMed  CAS  Google Scholar 

  • Black DM, Cummings SR, Karpf DB, et al. For the Fracture Intervention Trial Research Group. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fracture. Lancet 1996;348:1535–41.

    Article  PubMed  CAS  Google Scholar 

  • Liberman UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995;333:1437–43.

    Article  PubMed  CAS  Google Scholar 

  • Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999;282:1344–52.

    Article  PubMed  CAS  Google Scholar 

  • Reginster J, Minne HW, Sorensen OH, et al. Randomized trial of the effects of ridedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 2000;11:83–91.

    Article  PubMed  CAS  Google Scholar 

  • Chestnut CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004;19:1241–9.

    Article  CAS  Google Scholar 

  • McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001;344:333–40.

    Article  PubMed  CAS  Google Scholar 

  • Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1998;280:2077–82.

    Article  PubMed  CAS  Google Scholar 

  • Schnitzer T, Bone HG, Crepaldi S, et al. Therapeutic equivalence of alendronate 70 mg once weekly and alendronate 10 mg in the treatment of osteoporosis. Aging Clin Exp Res 2000;12:1–12.

    CAS  Google Scholar 

  • Brown JP, Kendler DL, McClung MR, et al. The efficacy and tolerability of risedronate once a week for the treatment of postmenopausal osteoporosis. Calcif Tissue Int 2002;71:103–11.

    Article  PubMed  CAS  Google Scholar 

  • Sorenson O, Crawford GM, Mulder H, et al. Long-term efficacy of risedronate: a 5-year placebo-controlled clinical experience. Bone 2003;32:120–6.

    Article  CAS  Google Scholar 

  • Bone H, Hosking D, Devolelaer T, et al. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004;350:1189–99.

    Article  PubMed  CAS  Google Scholar 

  • Marx RE. Pamidronate (Aredia) and zolendronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic. J Oral Maxillofac Surg 2003;61:1115–7.

    Article  PubMed  Google Scholar 

  • Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL. Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. J Oral Maxillofac Surg 2004;62:527–34.

    Article  PubMed  Google Scholar 

  • Lindsay R, Hart DM, Forrest C, Baird C. Prevention of spinal osteoporosis in oophorectomised women. Lancet 1980;2:1151–4.

    Article  PubMed  CAS  Google Scholar 

  • The Writing Group for the PEPI. Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions (PEPI) trial. JAMA 1996;276:1389–96.

    Article  Google Scholar 

  • Pors Nielsen S, Barenholdt O, Hermansen F, Munk-Jensen N. Magnitude and pattern of skeletal response to long term continuous and cyclic sequential estrogen/progesting treatment. Br J Obstet Gynaecol 1994;101:319–24.

    PubMed  CAS  Google Scholar 

  • Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321–33.

    Article  PubMed  CAS  Google Scholar 

  • Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA 2002;288:321–30.

    Article  PubMed  CAS  Google Scholar 

  • Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004;291:1701–12.

    Article  PubMed  CAS  Google Scholar 

  • Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 1999;282:637–45.

    Article  PubMed  CAS  Google Scholar 

  • Cauley JA, Norton L, Lippman ME, et al. Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Breast Cancer Res Treat 2001;65:125–34.

    Article  PubMed  CAS  Google Scholar 

  • Reginster JY, Deroisy R, Lecart MP, et al. A double-blind, placebo-controlled, dose-finding trial of intermittent nasal salmon calcitonin for prevention of postmenopausal lumbar spine bone loss. Am J Med 1995;98:452–8.

    Article  PubMed  CAS  Google Scholar 

  • Overgaard K, Riis BJ, Christiansen C, et al. Effect of salcatonin given intranasally on early postmenopausal bone loss. BMJ 1989;299:477–9.

    PubMed  CAS  Google Scholar 

  • Overgaard K, Hansen MA, Jensen SB, Christiansen C. Effect of salcatonin given intranasally on bone mass and fracture rates in established oseoporosis: a dose response study. BMJ 1992;305:556–61.

    Article  PubMed  CAS  Google Scholar 

  • Chestnut III CH, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. Am J Med 2000;109:267–76.

    Article  Google Scholar 

  • Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (I-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001;344:1434–41.

    Article  PubMed  CAS  Google Scholar 

  • Black DM, Greenspan SK, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 2003;349:1207–15.

    Article  PubMed  CAS  Google Scholar 

  • Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, et al. Effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003;349:1216–26.

    Article  PubMed  CAS  Google Scholar 

  • Cosman F, Nieves J, Zion M, et al. Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med 2005;353:566–75.

    Article  PubMed  CAS  Google Scholar 

  • Black DM, Bilezikian JP, Ensrud KE, et al. One year of alendronate after one year of parathyroid hormone (I-84) for osteoporosis. N Engl J Med 2005;353:555–65.

    Article  PubMed  CAS  Google Scholar 

  • Meunier PJ, Roux C, Seeman E, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004;350:459–68.

    Article  PubMed  CAS  Google Scholar 

  • Reginster JY, Seeman E, De Vernejoul MC, et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) study. J Clin Endocr Metab 2005;90:2816–22.

    Article  PubMed  CAS  Google Scholar 

  • McClung MR, Lewiecki EM, Cohen SB, et al. Denosumab in postmenopausal women with low bone mineral density. N Engl J Med 2006;354:821–31.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Geriatrics, Department of Medicine, New York Medical College, Valhalla, NY, USA

    Gayatri Gupta & Wilbert S. Aronow

  2. Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, NY, USA

    Wilbert S. Aronow

  3. Division of Pulmonary/Critical Care, Department of Medicine, New York Medical College, Valhalla, NY, USA

    Wilbert S. Aronow

  4. Cardiology Division, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY, 10595, USA

    Wilbert S. Aronow

Authors
  1. Gayatri Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wilbert S. Aronow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wilbert S. Aronow.

Additional information

Drs. Gupta and Aronow have no real or apparent conflicts of interest relating to the subject under discussion.

About this article

Cite this article

Gupta, G., Aronow, W.S. Treatment of Postmenopausal Osteoporosis. Compr Ther 33, 114–119 (2007). https://doi.org/10.1007/s12019-007-0017-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12019-007-0017-x

Keywords

Search

Navigation