The hormonal changes that take place at menopause are the most important reason why women are at greater risk of osteoporosis than men.
Fragility fractures osteoporosis related are a relevant cause of disability and excess mortality in postmenopausal women.
General measures such as calcium and vitamin D supplementation or physical exercise could be very useful for prevention of fragility fractures.
The use of registered drugs is recommended when the health benefits overcome the risks. The FRAX® algorithm is a scientifically validated risk assessment tool that improves identification of patients at high risk of fracture.
Antiresorptive agents are the predominant therapeutic category for preventing fractures, and bisphosphonates are still the most commonly used. However, new and more effective therapies are nowadays available for prevention and treatment of bone loss.
This is a preview of subscription content, log in to check access.
Abrahamsen B, et al. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res. 2009a;24:1095–102.CrossRefPubMedPubMedCentralGoogle Scholar
Baim S, et al. Assessing the clinical utility of serum CTX in postmenopausal osteoporosis and its use in predicting risk of osteonecrosis of the jaw. J Bone Miner Res. 2009;24:561–74.CrossRefPubMedPubMedCentralGoogle Scholar
Black DM, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296:2927–38.CrossRefPubMedPubMedCentralGoogle Scholar
Burghardt AJ, et al. A longitudinal HR-pQCT study of alendronate treatment in postmenopausal women witeh low bone density: relations among density, cortical and trabecular microarchitecture, biomechanics, and bone turnover. J Bone Miner Res. 2010;25:2558–71.CrossRefPubMedPubMedCentralGoogle Scholar
Chapurlat RD, et al. Microcrack frequency and bone remodeling in postmenopausal osteoporotic women on long-term bisphosphonates: a bone biopsy study. J Bone Miner Res. 2007;22:1502–9.CrossRefPubMedPubMedCentralGoogle Scholar
Collins P, et al. Effects of the selective estrogen receptor modulator raloxifene on coronary outcomes in the Raloxifene Use for The Heart trial: results of subgroup analyses by age and other factors. Circulation. 2009;119:922–30.CrossRefPubMedPubMedCentralGoogle Scholar
Cosman F, et al. Effects of intravenous zoledronic acid plus subcutaneous teriparatide (rhPTH(1–34)) in postmenopausal osteoporosis. J Bone Miner Res. 2011;26:503–11.CrossRefPubMedPubMedCentralGoogle Scholar
Cosman F, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359–2381.Google Scholar
Cosman F, et al. FRAME study: the foundation effect of building Bone with 1 year of Romosozumab leads to continued lower fracture risk after transition to Denosumab. J Bone Miner Res. 2018;33:1219–26.CrossRefPubMedPubMedCentralGoogle Scholar
EPOS Group, et al. Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporosis Int. 2002;13:565–71.CrossRefGoogle Scholar
Eriksen EF, et al. Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res. 2009;24:1308–13.CrossRefPubMedPubMedCentralGoogle Scholar
Haentjens P, On behalf of the Network on Male Osteoporosis in Europe (NEMO), et al. Evidence from data searches and life-table analyses for gender-related differences in absolute risk of hip fracture after Colles’ or spine fracture: Colles’ fracture as an early and sensitive marker of skeletal fragility in white men. J Bone Miner Res. 2004;19:1933–44.CrossRefPubMedPubMedCentralGoogle Scholar
Harris ST, et al. Ibandronate and the risk of non-vertebral and clinical fractures in women with postmenopausal osteoporosis: results of a meta-analysis of phase III studies. Curr Med Res Opin. 2008;24:237–45.CrossRefPubMedPubMedCentralGoogle Scholar
Hodsman AB, et al. Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev. 2005;26:688–703.CrossRefPubMedPubMedCentralGoogle Scholar
Hoff AO, et al. Frequency and risk factors associated with osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates. J Bone Miner Res. 2008;23:826–36.CrossRefPubMedPubMedCentralGoogle Scholar
Kelley GA, et al. Exercise and bone mineral density in premenopausal women: a meta-analysis of randomized controlled trials. Int J Endocrinol. 2013;2013:741639.PubMedPubMedCentralGoogle Scholar
Kenneth G, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017;377:1417–27.CrossRefGoogle Scholar
Lee S, et al. Efficacy, side effects and route of administration are more important than frequency of dosing of anti-osteoporosis treatments in determining patient adherence: a critical review of published articles from 1970 to 2009. Osteoporos Int. 2011;22:741–53.CrossRefPubMedPubMedCentralGoogle Scholar
Leeming DJ, et al. An update on biomarkers of bone turnover and their utility in biochemical research and clinical practice. Eur J Clin Pharmacol. 2006;62:781–92.CrossRefGoogle Scholar
Melton LJ III, et al. Epidemiology of vertebral fractures: implications for vertebral augmentation. Acad Ther. 2006;13:538–45.Google Scholar
Meunier PJ, et al. Effects of long-term strontium ranelate treatment on vertebral fracture risk in postmenopausal women with osteoporosis. Osteoporos Int. 2009;20:1663–73.CrossRefPubMedPubMedCentralGoogle Scholar
Miller PD, et al. Effect of denosumab on bone density and turnover in postmenopausal women with low bone mass after long-term continued, discontinued, and re- starting of therapy: a randomized blinded phase2 clinical trial. Bone. 2008;43:222–9.CrossRefPubMedPubMedCentralGoogle Scholar
Miller PD, et al. Denosumab or zoledronic acid in postmenopausal women with osteoporosis previously treated with oral bisphosphonates. J Clin Endocrinol Metab. 2016;101:3163.CrossRefPubMedPubMedCentralGoogle Scholar
Moreira LDF, et al. Physical exercise and osteoporosis: effects of different types of exercises on bone and physical function of postmenopausal women. Arq Bras Endocrinol Metabol. 2014;58(5):514–22.CrossRefPubMedPubMedCentralGoogle Scholar
Mosca L, et al. Effect of raloxifene on stroke and venous thromboembolism according to subgroups in postmenopausal women at increased risk of coronary heart disease. Stroke. 2009;40:147–55.CrossRefPubMedPubMedCentralGoogle Scholar
Ominsky MS, et al. Tissue-level mechanisms responsible for the increase in bone formation and bone volume by sclerostin antibody. J Bone Miner Res. 2014;29:1424–30.CrossRefPubMedPubMedCentralGoogle Scholar
Reginster JY, Rabenda V, et al. Adherence to anti-osteoporotic treatment: does it really matter? Future Rheumatol. 2006;1(1):37–40.CrossRefGoogle Scholar
Reid DM, et al. Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis (HORIZON): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2009;373:1253–63.CrossRefPubMedPubMedCentralGoogle Scholar
Silverman SL, et al. Efficacy of bazedoxifene in reducing new vertebral fracture risk in postmenopausal women with osteoporosis: results from a 3-year, randomized, placebo-, and active-controlled clinical trial. J Bone Miner Res. 2008;23:1923–34.CrossRefPubMedPubMedCentralGoogle Scholar
Tsai JN, et al. Comparative effects of teriparatide, denosumab, and combination therapy on peripheral compartmental bone density, microarchitecture, and estimated strength, the DATA-HRpQCT Study. J Bone Miner Res. 2015;30(1):39–45.CrossRefPubMedPubMedCentralGoogle Scholar
van Bezooijen RL, et al. Wnt but not BMP signaling is involved in the inhibitory action of sclerostin on BMP-stimulated bone formation. J Bone Miner Res. 2007;22:19–28.CrossRefPubMedPubMedCentralGoogle Scholar
Weycker D, et al. Compliance with drug therapy for postmenopausal osteoporosis. Osteoporosis Int. 2006;17:1645.CrossRefGoogle Scholar
Wijenayaka AR, et al. Sclerostin stimulates osteocyte support of osteoclast activity by a RANKL-dependent pathway. PLoS One. 2011;6:25900.CrossRefGoogle Scholar
Wilk A, et al. Post-fracture pharmacotherapy for women with osteoporotic fracture: analysis of a managed care population in the USA. Osteoporos Int. 2014;25:2777–86.CrossRefPubMedPubMedCentralGoogle Scholar
Yarom N, et al. Osteonecrosis of the jaw induced by orally administered bisphosphonates: incidence, clinical features, predisposing factors and treatment outcome. Osteoporos Int. 2007;18:1363–70.CrossRefPubMedPubMedCentralGoogle Scholar
Zanchetta JR, et al. Effects of teriparatide (recombinant human parathyroid hormone (1–34)) on cortical bone in postmenopausal women with osteoporosis. J Bone Miner Res. 2003;18:539–43.CrossRefPubMedPubMedCentralGoogle Scholar