Fractures, osteoporotic, prevention

It is useful to compare the activity profile of a SERM with that of estradiol, particularly in relation to effects seen postmenopausally. During chronic administration of estradiol, the risk of endometrial cancer rises co-ad-ministration of a progestin prevents this effect. Breast cancers occur more frequently, likewise thromboembolic diseases. Estradiol effectively alleviates climacteric hot flashes and sweating. After chronic treatment it reduces the incidence of osteoporotic bone fractures by preventing the loss of an estrogen-dependent portion of bone mass. Nonetheless, estrogens can no longer be recommended for this purpose because of the unfavorable benefit-risk constellation (p.330). 

Kobayashi K, Shimoyama K, Nakamura K et al (2005) Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 15 360-367... 

Assess nonpharmacologic interventions for preventing osteoporotic fractures, including nutrition, weightbearing and muscle-strengthening exercise regimens, and fall risk. 

Educate the patient about nonpharmacologic measures to prevent osteoporotic fractures. 

Research in humans has been mainly focused either in the prevention of osteoporosis in healthy postmenopausal women or in the treatment of already osteoporotic women. Some research programs have extensively used estimates of biochemical markers of bone remodeling, while others have mostly relied on evaluations of BMD, histomorphometry, and fracture incidence. 

Chesnut III CH, Silverman S, Andriano K, Genant H, Gimona A, Harris S, Kiel D (2000) A randomised trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis the prevent recurrence of osteoporotic fractures study. Am J Med 109 267-276... 

Non-compliance is a serious problem in the prevention of osteoporosis and osteoporotic fractures. This is due to adverse effects, lack of noticeable benefit and ignorance. It is difficult to convince regular intake of oral calcium, biphosphonates, vitamin D and in post-menopausal women hormone replacement. Long-term compliance to hormone replacement is worse in developing countries. The most cost-effective therapy for osteoporosis is primary prevention. 

Jones CE, Faulkner DL, Kent GN, Bhagat Cl, Nicholson GC, Jamrozik K. A randomized trial of sodium fluoride (60 mg) +/— estrogen in postmenopausal osteoporotic vertebral fractures increased vertebral fractures and peripheral bone loss with sodium fluoride concurrent estrogen prevents peripheral loss, but not vertebral fractures Osteoporos Int 2002 13(2) 158-70. 

Zizic TM. Pharmacologic prevention of osteoporotic fractures. Am Fam Physician. 2004 70 1293-1300. 

Col NF, Bowlby LA, McGarry K. The role of menopausal hormone therapy in preventing osteoporotic fractures a critical review of the clinical evidence. Minerva Med. 2005 96 331-342. 

NICE (National Institute for Health and Clinical Excellence) (2005) Bisphosphonates (alendronate, etidronate, risedronate), selective oestrogen receptor modulators (raloxifene) and parathyroid hormone (teriparatide) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. Available at www.nice.org.uk/nicemedia/pdf/TA087guidance.pdf [Accessed 4 July 2008],... 

Bisphosphonates are licensed for use in postmenopausal osteoporosis and glucocorticoid induced osteoporosis. They are often used in older women with osteoporosis and they are recommended by NICE as the first-line agent for the secondary prevention of osteoporotic fractures in postmenopausal women. Alendronate and etidronate are licensed for men with osteoporosis. 

National Institute for Health and Clinical Excellence (2008) NICE Technology appraisal 161, Osteoporosis - secondary prevention, including strontium ranelate. Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for secondary prevention of osteoporotic fractures in post menopausal women. Available at http //www.nice.org.uk/Guidance/TA161 [Accessed 18 November 2008],... 

Teriparatide (a recombinant human parathyroid hormone) stimulates bone formation and is given daily by subcutaneous injection. There is evidence that teriparatide reduces vertebral and non-vertebral fractures. NICE recommends that it should be considered for the secondary prevention of osteoporotic fragility fractures in women aged 65 years and over who are intolerant of... 

To prevent the long-term complications associated with oestrogen deficiency osteoporotic fractures (see Chapter 38) and coronary heart disease... 

Annnal direct costs for osteoporotic fractnres were estimated to be 17 bUhon (in 2001 doUars). A hip fractnre costs abont 40,000 (in 2001 dollars). Health care costs for women aged 45 and older indicate that osteoporosis acconnts for 6.9% of direct medical expenditnres, with one-half of these expenses borne by Medicare. Direct costs in the year following hip fracture range from 16,000 to 36,000. Indirect costs of hip fracture, including lost quality of life, add at least 20,000 per fracture. Appreciation of these costs and availability of preventive therapies have established osteoporosis as a significant public health priority. 

Vitamin D and Its Analogs The role for oral supplementation with vitamin D also has been controversial at least one prospective trial found that neither vitamin D nor calcium had a major impact on prevention of osteoporotic fractures in women. Nonetheless, supplemental vitamin D may be of value in patients whose intake appears inadequate based on dietary assessment. 

Estrogen Postmenopausal status or estrogen deficiency at any age significantly increases the risk for osteoporosis. Likewise, overwhelming evidence supports the positive impact of postmenopausal estrogen replacement on bone conservation and protection against osteoporotic fractures. The apparently increased risk of adverse cardiovascular events in prospective studies has led to the recommendation that hormone replacement therapy should not be first-line therapy for prevention or treatment of osteoporosis. 

Rodents lack lamellar bone and have a limited capacity for bone remodelling. It has been proposed (Heaney, 1981) that remodelling (i.e., turnover of local bone units) in the human is necessary to prevent bone fatigue . Slow remodelling (which is initiated by osteoclastic resorption of bone units under the stimulus of parathyroid hormone) has been associated with sites of osteoporotic fractures. It is of interest, therefore, that fractures have not yet been associated with a slow rate of remodelling in... 

Raloxifene is the only selective oestrogen receptor modulator approved for long-term treatment in the prevention of osteoporotic fractures and for the reduction of invasive breast cancer risk in postmenopausal women. The efficacy and adverse effects of raloxifene as well as its molecular mechanism of action have been recently updated. It is noteworthy that quality-of-life studies demonstrated some favourable effects of raloxifene [32 ]. 

Other trials have shown an increased risk of falls and fractures with annual oral administration of high doses of vitamin D. Therefore, supplementation with more frequent, lower doses is preferred. Yet the optimal dosing schedule is unknown and needs further investigation. In order to treat age-associated secondary hyperparathyroidism and to prevent osteoporotic fractures, a daily dose of 1000-1200 mg calcium and 800 lU vitamin D is recommended in elderly or individuals on chronic glucocorticoid therapy. 

Coconut oil improves the ability of the body to absorb important minerals. This includes calcium and magnesium which are necessary for the development of bones and also reduces the oxidative stress within the bone, which may prevent structural damage in osteoporotic bone. Thus, coconut oil is very useful to women who are prone to osteoporosis (a disease of bone that can cause fractures) after middle age (Hegde, 2006 Hegde, 2009). 

Menopause begins a period of bone loss that extends until the end of life. It is the major contributor to higher rates of osteoporotic fractures in older women. The decrease in serum estrogen concentrations at menopause is associated with accelerated bone loss, especially from the spine, for the next 5 years, during which approximately 15% of skeletal calcium is lost. The calcium loss by women in early menopause cannot be prevented unless estrogen therapy is provided. Calcium supplements alone are not very helpful in preventing postmenopausal bone loss. Upon estrogen treatment, bone resorption is reduced and the intestinal calcium... 

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