Osteoporosis New Trends in Prevention and Treatment

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Osteoporosis New Trends inPrevention and
Treatment

• Prof. Bari Kaplan MD.
• . 2-4-2003

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The management of postmenopausal osteoporosis
first focuses on identifying the womans risk
factors, then selecting measures that will
reduce modifiable risk factors through lifestyle
changes and, if indicated, pharmacologic therapy.
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If pharmacologic therapy is indicated

• FDA-approved options are
• Estrogens (prevention only) according FDA new
  statement.
• Bisphosphonates and Selective estrogen-receptor
  modulators (prevention and treatment),
• Calcitonin (treatment only).
• PTH

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Anti fracture efficacy of the most frequently
used treatment of postmenopausal osteoporosis in
addition to the effects of calcium or vitamin D
supplementation, or both, as derived from placebo
controlled randomized trials.
Delmas, The Lancet 3592018-2026, 2002
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Magnitude of the Treatment Effect on Vertebral
and Non Vertebral Fractures in Postmenopausal
Woman with Osteoporosis
1.6
P lt 0.05
1.4
SPINE
P0.05
1.2
NONSPINE
1
Relative Risk for Fractures
0.8
0.6
0.4
0.2
0
CA n576
VIT D n1,130
ALN n9,360
RIS n2,604
RLX n6,828
HRT n3,117
SCT n1,108
FLU n646
ETD n1,076
CRANNEY A et al . ENDOCRINE REV 2002, 23(4)570 -
578 CACalcitonon,VIT DVitamin D,ALNAlendronate
,RISRisedronate ,RLXRaloxifen,SCTCalcitonin,FLU
Fluoride,ETD Etidronate
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Therapeutic Management of Postmenopausal
Osteoporosis
Short-term vasomotor symptom management
Osteoporosis preventionT-score 1 to 2.5
Osteoporosis treatment with or without previous
fracture T-score lt -2.5
Osteoporosis treatment with multiple
fractures and at risk for hip fracture
PTH
Raloxifene
HRT
Bisphosphonates
50 55 60 65 70 75 80 85 90
HRThormone replacement therapy
Age (years)
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Osteoporosis Therapy AlgorithmPostmenopausal
Women
Bisphosphonates
Lower
Higher
-2.5
BMD (T-score)