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Pharmacy World and Science

, Volume 20, Issue 5, pp 198–205 | Cite as

Prevention and Treatment of Postmenopausal Osteoporosis

  • R.B. Hallworth
Article

Abstract

The purpose of the review is to outline the interventions, both pharmacological and non‐pharmacological, available to prevent postmenopausal osteoporosis (PMO) and treat the established disease. Current suggested guidelines for the most cost‐effective treatment and prophylactic strategies are included following a consideration of the available options. As life expectancy has increased so has the incidence of PMO which has major quality of life implications for the sufferers and economic implications for the authorities responsible for their treatment. PMO represents a significant public health problem and although more effective treatments are becoming available prevention of the disease by taking account of existing risk factors is preferable. Indeed, a population approach to prevention may be more cost effective than screening for the disease. Attention to dietary calcium intake and exercise regimes have been shown to be effective prophylactic measures premenopausally, while the treatment of choice is hormone replacement therapy (HRT). HRT treats other postmenopausal symptoms in addition to PMO and is available in many presentations, containing different hormones, at different doses intended for different routes of administration. The optimum treatment duration is controversial and may contribute to some of the risks associated with HRT such as endometrial and breast carcinoma and venous thromboembolism (VTE). Newer effective treatments include the bisphosphonates and novel formulations of calcitonin, but older approaches such as vitamin D, anabolic steroids and fluoride are still utilised in some circumstances. However, most promise has been shown by synthetic hormonal modulators currently being trialled.

Bisphosphonates Calcium Hormone Replacement Therapy Menopause Osteoporosis 

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References

  1. 1.
    Effective Healthcare Bulletin No. 1. Screening for osteoporosis to prevent fractures. Department of Public Health Medicine. University of Leeds;1991:1–12.Google Scholar
  2. 2.
    Cummings SR, Kelsey JL, Nevitt MC, et al. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178–208.Google Scholar
  3. 3.
    Cooney LM, Marottoli RA. Functional decline following hip fracture. In Christiansen C, Riis B, eds. Osteoporosis 1993, proceedings of IV Int. Symposium on Osteoporosis and Consensus Development Conference. Hong Kong 1993. Rodovre, Denmark: 480–481.Google Scholar
  4. 4.
    Osteoporotic hip fractures in men and women could triple by the year 2040. Pharmaceutical Journal 1996;256: 888.Google Scholar
  5. 5.
    Office of Population Censuses and Surveys. Mortality Statistics 1990, Series DH2, No. 17. London: HM Stationery Office, 1991.Google Scholar
  6. 6.
    McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas 1992;14:103–15.Google Scholar
  7. 7.
    Screening for Osteoporosis to Prevent Fractures. Effective Health Care. School of Public Health, University of Leeds. Centre for Health Economics, University of York. No.1; January 1992.Google Scholar
  8. 8.
    Pitt F, Lloyd-Jones M., Brazier J, et al.The costs and benefits of screening and preventing post-menopausal osteoporosis in Trent Region. Trent Osteoporosis Working Group, 1990.Google Scholar
  9. 9.
    New test for osteoporosis. Pharmaceutical Journal. 1995;255:369.Google Scholar
  10. 10.
    Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. NEJM 1995;332:767–73.Google Scholar
  11. 11.
    American College of Physicians. Ann Intern Med 1992;117: 1016–37.Google Scholar
  12. 12.
    Arden N, Spector T. Risk factors for hip fracture. Osteoporosis Review 1996;1:1–2.Google Scholar
  13. 13.
    Hansen MA, Overgaard K, Rus BJ, et al. Potential risk factors for development of postmenopausal osteoporosis-examined over a 12 year period. Osteoporos Int1991;1:95–102.Google Scholar
  14. 14.
    Walsh LJ, Wong CA, Pringle M, et al. Use of oral corticosteroids in the community and the prevention of secondary osteoporosis: a cross sectional study. BMJ 1996;313:344–6.Google Scholar
  15. 15.
    Cooper C, Coupland C, Mitchell M. Rheumatoid arthritis, corticosteroid therapy and hip fracture. Ann Rheum Dis 1995;54:49–52.Google Scholar
  16. 16.
    Adachi JD, Bensen WG, Bianchi F, et al. Vitamin D and calcium in the prevention of corticosteroid induced osteoporosis: a three year follow up. J Rheumatol 1996;23:995–1000.Google Scholar
  17. 17.
    Lo-Cascio V, Bonucci E, Imbimbo B, et al. Bone loss after glucocorticoid therapy. Calcif Tissue Int 1984;36:435–8.Google Scholar
  18. 18.
    Messina OD, Barreira JC, Zanchetta JR, et al. Effect of low doses of deflazocort vs. prednisone on bone mineral content in premenopausal rheumatoid arthritis. J Rheumatol 1992;19:1520–6.Google Scholar
  19. 19.
    Olgaard K, Storm T, Von Wowern N, et al. Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandible of nephrotic patients: a double blind study on the high dose, long-term effects of prednisone versus deflazocort. Calcif Tissue Int 1992;50:490–7.Google Scholar
  20. 20.
    McKnight A, Steele K, Mills K, et al. Bone mineral density in relation to medical and lifestyle risk factors for osteoporosis in premenopausal, menopausal and postmenopausal women in general practice. BJGP 1995;45: 317–20.Google Scholar
  21. 21.
    Royal College of Physicians. Fractured neck of femur, prevention and management. Summary and recommendations of a report of the Royal College of Physicians. J R Coll Physicians Lond 1989;23:8–12.Google Scholar
  22. 22.
    Christiansen C and Riis BJ. 17 beta-oestradiol and continuous norethisterone: A unique treatment for established osteoporosis in elderly women.J of Clin Endocrin and Metab 1990;71:836–41.Google Scholar
  23. 23.
    Lindsay R, Hart DM, Aitken JM, et al. Long-term prevention of postmenopausal osteoporosis by oestrogen. Lancet 1976;i:1035–41.Google Scholar
  24. 24.
    Hormone Replacement Therapy. MeReC Bulletin 1993, Vol.4 No.2, 5–8.Google Scholar
  25. 25.
    Stevenson JC, Kanis JA, Christiansen C. Bone mass in women after withdrawal of oestrogen/gestagen replacement therapy. Lancet 1992;339:370–1.Google Scholar
  26. 26.
    Spector TD. Use of oestrogen replacement therapy in high risk groups in the United Kingdom. BMJ 1989;299:143–5.Google Scholar
  27. 27.
    Advisory group on osteoporosis. Report. London: Department of Health, 1994.Google Scholar
  28. 28.
    Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA 1991;265:1861–7.Google Scholar
  29. 29.
    Munk-Jensen N, et al. Continuous combined and sequential estradiol and norethindrone acetate treatment of postmenopausal women: Effect on plasma lipoproteins in a two year placebo controlled trial. Am J of Obstet and Gyne 1994;171:132–13.Google Scholar
  30. 30.
    HRT as a treatment for hyperlipidaemia? Pharmaceutical Journal 1995;255:804.Google Scholar
  31. 31.
    Paganini-Hill A, Henderson VW. Estrogen deficiency and risk of Alzheimer's disease in women. Am J Epidemiol 1994; 140:256–61.Google Scholar
  32. 32.
    Tang M-X, Jacobs D, Stern Y, et al. Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease. Lancet 1996;348:429–32.Google Scholar
  33. 33.
    Ettinger B, Selby J, Citron J, et al. Cyclic hormone replacement therapy using quarterly progestin. Obstetrics and Gynecology. 1994;83:693–670.Google Scholar
  34. 34.
    Ellerington MC, Stevenson JC. Drugs & ageing 1992;2:508–17.Google Scholar
  35. 35.
    Doubt is cast on the adequacy of HRT for bone protection. Pharmaceutical Journal 1997;258:398.Google Scholar
  36. 36.
    Brough RJ, O'Flynn K. Recurrent pelvic endometriosis and bilateral ureteric obstruction associated with hormone replacement therapy. BMJ 1996;312:1221–2.Google Scholar
  37. 37.
    Stevenson JC, Cust MP, Gangar KF, et al. Effects of transdermal versus oral hormone replacement therapy on bone density in spine and proximal femur in postmenopausal women. Lancet 1990;336:265–9.Google Scholar
  38. 38.
    Brockie J. Oestrogel: new oestrogen replacement therapy gel. Prescriber 1995;6:76–80.Google Scholar
  39. 39.
    Treatment and prevention of osteoporosis. MeReC Bulletin. 1994;Vol.5 No.3:9–12.Google Scholar
  40. 40.
    10 year HRT benefit. Pharmaceutical Journal 1996;256:707.Google Scholar
  41. 41.
    Udoff L, Langenberg P, Adashi EY. Combined continuous hormone replacement therapy: A critical review. Obstet Gynecol 1995;86:306–16.Google Scholar
  42. 42.
    Few continue HRT beyond five years. Pharmaceutical Journal. 1997; 258: 398.Google Scholar
  43. 43.
    Jacobs HS, Loeffler FE. Postmenopausal hormone replacement therapy. BMJ 1992;305:1589–93.Google Scholar
  44. 44.
    Speroff L. Postmenopausal hormone therapy and breast cancer. Obs Gyn 1996;87:44S–54S.Google Scholar
  45. 45.
    Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in post-menopausal women. NEJM 1995;332:1589–93.Google Scholar
  46. 46.
    DiSaia P, Odicino F, Grosen E, et al. Hormone replacement therapy in breast cancer. Lancet 1993;342:1232.Google Scholar
  47. 47.
    Kauffman RF, Bryant HU. Selective estrogen receptor modulators. Drug News & Perspectives 1995;8:531–9.Google Scholar
  48. 48.
    Endometrial cancer still a risk with combined, cyclic HRT. Pharmaceutical Journal 1997;258:262.Google Scholar
  49. 49.
    Risk of venous thromboembolism with hormone replacement therapy. Current Problems in Pharmacovigilance. CSM & MCA London. 1996;22:9–10.Google Scholar
  50. 50.
    Thrombosis risk reported in users of hormone replacement therapy. Lancet 1996;348:977.Google Scholar
  51. 51.
    HRT; venous thrombosis risk limited to first year. Pharmaceutical Journal 1997;258:398.Google Scholar
  52. 52.
    Cramer DW, Hutchinson GB, Welch WR, et al. Determinants of ovarian cancer risk: reproductive experiences and family history. Journal of the National Cancer Institute 1983;71:711–716.Google Scholar
  53. 53.
    Dawson-Hughes B, Dallal GE, Krall EA, et al. A controlled trial of the effect of calcium supplementation on bone density in postemenopausal women. NEJM 1990;323:878–83.Google Scholar
  54. 54.
    Reid IR, Ames RW, Evans MC, et al. Effect of calcium supplementation on bone loss in postmenopausal women.NEJM 1993;328:460–4.Google Scholar
  55. 55.
    Meyer HE, Tverdal A, Falch JA. Risk factors for hip fracture in middle-aged Norwegian women and men. American Journal of Epidemiology 1993;137:1203–11.Google Scholar
  56. 56.
    Heinonen A, Kannus P, Sievanen H, et al. Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet 1996;348:1343–7.Google Scholar
  57. 57.
    Hatori M, Hasegawa A, Adachi H, et al. The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women. Calcified Tissue International 1993;52:411–4.Google Scholar
  58. 58.
    Storm T, Thamsborg G, Steiniche T, et al. Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. NEJM 1990;322:1265–71.Google Scholar
  59. 59.
    Watts NB, Harris ST, Genant HK, et al. Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. NEJM 1990;323:73–9.Google Scholar
  60. 60.
    Liberman UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postemenopausal osteoporosis. N Eng. J Med. 1995;333: 1437–43.Google Scholar
  61. 61.
    Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996;348:1535–40.Google Scholar
  62. 62.
    Chestnut CH, et al. Alendronate treatment of the postmenopausal osteoporotic woman: Effect of multiple dosages on bone mass and bone remodelling. Am J Med 1995;99:144–52.Google Scholar
  63. 63.
    Chapuy MC, Arlot ME, Delmas PD, et al. Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994;308:1081–2.Google Scholar
  64. 64.
    Heikinheimo RJ, Inkovaara JA, Harju EJ, et al. Annual injection of vitamin D and fractures of aged bones. Calcif Tissue Int 1992;51:105–10.Google Scholar
  65. 65.
    Van der Wielen RPJ, Lowik MRH, van den Berg H, et al. Serum vitamin D concentrations among elderly people in Europe. Lancet 1995;346:207–10.Google Scholar
  66. 66.
    Overgaard K, Hansen MA, Jensen SB, et al. Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. BMJ 1992;305: 556–61.Google Scholar
  67. 67.
    ChesnutIII CH, Ivey JL, Gruber HE, et al. Stanzolol in post-menopausal osteoporosis: therapeutic efficacy and possible mechanisms of action. Metabolism 1983;32:571–80.Google Scholar
  68. 68.
    Need AG, Chatterton BE, Walker CJ, et al. Comparison of calcium, calcitriol, ovarian hormones and nandrolone in the treatment of osteoporosis. Maturitas 1986; 8:275–80.Google Scholar
  69. 69.
    Pak CYC, Sakhaee K, Adams-Huet B, et al. Treatment of post-menopausal osteoporosis with slow-release sodium fluoride. Final report of a randomized controlled trial. Ann Intern Med 1995; 123: 401–8.Google Scholar
  70. 70.
    Love RR, Barden HS, Mazess RB, et al. Effect of tamoxifen on lumbar spine bone mineral density in postmenopausal women after five years. Arch Int Med 1994;154:2585–8.Google Scholar

Copyright information

© Kluwer Academic Publishers 1998

Authors and Affiliations

  • R.B. Hallworth
    • 1
  1. 1.High Lane Pharmacy, High Lane, Stockport, Cheshire, U.K. Stockport Health Authority, Springwood House, Poplar Grove, Hazel Grove, Stockport, Cheshire, U.K. Centre for Pharmacy Postgraduate Education, Pharmacy DepartmentUniversity of ManchesterManchesterU.K.

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