C. Treatment of Postmenopausal Osteoporosis
  • Nelson B. Watts


  • The main goal of osteoporosis treatment is the prevention of fractures.

  • Increases in bone density through the use of medications explain only a small proportion of the observed reduction in fracture risk. This suggests that agents that have some additional effects on bone quality to account for the reduction in fracture risk.

  • Important considerations in bone health include adequate intake of calcium and vitamin D, regular weight-bearing exercise, and avoidance of cigarette smoking and other negative factors.

  • Pharmacologic intervention is indicated for women who have T scores of -2.5 and below and for women with risk factors whose T scores are -1.5 or below.

  • Medications employed to treat osteoporosis include the bisphosphonates, calcitonin, selective estrogenreceptor modulators (SERMs), and parathyroid hormone.

  • Pharmacologic medications for the treatment of osteoporosis are classifi ed as either antiresorptive or anabolic agents. The only anabolic drug available currently is teriparatide (parathyroid hormone).

  • Bisphosphonates work through two broad mechanisms: They reduce the ability of individual osteoclasts to resorb bone and they accelerate osteoclast apoptosis (programmed cell death).

  • Calcitonin reduces bone resorption by binding to specifi c osteoclast receptors.

  • Selective estrogen-receptor modulators produce different expression of estrogen-regulated genes in different tissues, activating some and inhibiting others. The net effect of this is a reduction in bone resorption and possibly a reduction in the risk of breast cancer.

  • Teraparatide stimulates bone formation, producing gains in spine bone mineral density two to three times greater than those observed with antiresorptive drugs.

  • ■ Bisphosphonates remain the first-line therapy for most patients, but teraparatide may be preferred for higher risk patients and for those failing to achieve a desired response to treatment with antiresorptive drugs.


Bone Mineral Density Vertebral Fracture Fracture Risk Parathyroid Hormone Zoledronic Acid 
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Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Nelson B. Watts
    • 1
  1. 1.Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiUSA

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