Prevention Early After Menopause

  • John C. Stevenson


  • Early intervention is clearly an important strategy for the prevention of postmenopausal osteoporosis.

  • Prevention of osteoporosis with HRT can still be considered a first-line strategy, but risks and benefits need to be assessed in each individual case. Such treatment leads to improved longevity and quality of life. It also relieves menopausal symptoms and decreases the incidence of other menopause-related conditions affecting the urogenital and central nervous systems. It may, however, have some undesirable adverse effects.

  • An alternative for estrogens to prevent osteoporosis is raloxifine. Other anti-resorptive drugs, such as bisphosphonates, play an important role in preventing osteoporosis and bone fractures. Calcitonin has only a limited place in therapy.

  • The roles of calcium intake and physical activity are secondary in the prevention of osteoporosis during the early postmenopause. rhPTH may be a promising agent for the future, but it is more likely to be used for the treatment than the prevention of osteoporosis.

The development of osteoporosis depends on both the peak bone mass attained and its subsequent loss. Peak bone mass is achieved in early adulthood and is determined largely genetically. To a lesser extent, bone mass is dependent on diet, exercise, alcohol consumption, smoking, drugs (e.g, corticosteroids, contraceptive pills), parity, and the presence or absence of ovarian function.

The development of osteoporosis results from an imbalance between bone resorption and bone formation. The loss of gonadal function and aging are the two most important factors. Starting around the fourth or fifth decade of life, men and women lose 0.3–0.5% of bone a year. After the loss of gonadal function, this is increased by up to tenfold in women due to an increase in bone turnover.


Vertebral Fracture Peak Bone Mass Salmon Calcitonin Prevent Bone Loss Gonadal Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Further Reading

  1. Beral V. Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003; 362: 419–27.PubMedCrossRefGoogle Scholar
  2. Cummings SR, Black DM, Thompson DE, et al. (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. J Am Med Assoc 280: 2077–2082.Google Scholar
  3. Dawson-Hughes B (1995) Prevention. In: Riggs BL, Melton LJ III (eds). Osteoporosis 2nd edn. Philadelphia: Lippincott-Raven, pp. 335–350.Google Scholar
  4. Ellerington MC, Hillard RC, Whitcroft SIJ, et al. (1996) Intranasal salmon calcitonin for the prevention and treatment of postmenopausal osteoporosis. Calcif Tissue Int 59: 6–11.Google Scholar
  5. Gallagher JC, Baylink DJ, Freeman R, McClung M (2001) Prevention of bone loss with tibolone in postmenopausal women: results of two randomised, double-blind, placebo-controlled, dose-finding studies. J Clin Endocrinol Metab 86: 4717–4726.PubMedCrossRefGoogle Scholar
  6. Hanley DA, Loannidis G, Adachi JD (2000) Etidronate therapy in the treatment and prevention of osteoporosis. J Clin Densitom 3: 79–95.PubMedCrossRefGoogle Scholar
  7. Lees B, Stevenson JC (2001) The prevention of osteoporosis using sequential low-dose hormone replacement therapy with estradiol-17/3 and dydrogesterone. Osteoporos Int 12: 251–258.PubMedCrossRefGoogle Scholar
  8. McClung MR, Geusens P, Miller PD, et al. (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344: 333–340.Google Scholar
  9. Neer RM, Arnaud CD, Zanchetta JR, et al. (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344: 1434–1441.PubMedCrossRefGoogle Scholar
  10. Spencer CP, Stevenson JC (1997) Oestrogens and anti-oestrogens for the prevention and treatment of osteoporosis. In: Meunier P (ed.). Osteoporosis: Diagnosis and Management. London: Martin Dunitz, pp. 111–122.Google Scholar
  11. Stevenson JC (1996) Benefitsand risks of hormone therapy. In: Weatherall DJ, Ledingham JGG, Warren DA (eds). Oxford Textbook of Medicine, 3rd edn. Oxford: Oxford Medical Publication, 1813–1815.Google Scholar
  12. Stevenson JC (1998) Is there a case for target ing hormone replacement therapy for osteoporos is at the menopause? Osteoporos Int 8 (supplement I): 47–50.CrossRefGoogle Scholar
  13. Writing Group for the Women’s Health Initiative Investigators. 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: 321–333.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2004

Authors and Affiliations

  • John C. Stevenson

There are no affiliations available

Personalised recommendations