Osteoporosis management

The primary goal of osteoporosis management is prevention. Optimizing skeletal development and peak bone mass accrual in childhood, adolescence, and early adulthood will reduce the future incidence of osteoporosis. 

Osteoporosis Several new reviews summarise the available evidence-based data that form the basis for therapeutic intervention and covers the current status of glucocorticoid-induced osteoporosis management, regulatory requirements and risk-assessment options 37, ] and also osteonecrosis [38 39, ]. 

REHMAN M, HOYLAND J, DENTON J and FREEMONT A J (1995) Histomorphometiic classification of postmenopausal osteoporosis implications for the management of osteoporosis. J Clin Pathol. 48 (3) 229-35. 

The growth and spread of thyroid carcinoma is stimulated hy TSH. An important component of thyroid carcinoma management is the use ofLT4 to suppress TSH secretion. Early in therapy, patients receive the lowest LT4 dose sufficient to fully suppress TSH to undetectable levels. Controlled trials show that suppressive LT4 therapy reduces tumor growth and improves survival. These patients are purposefully overtreated with LT4 and rendered subclinically hyperthyroid. Postmenopausal women should receive aggressive osteoporosis therapy to prevent LT4-induced bone loss. Other thyrotoxic complications, such as atrial fibrillation, should be monitored and managed appropriately. 

Compston, J. 2005. Recombinant parathyroid hormone in the management of osteoporosis. Calcified Tissue International 77(2), 65-71. 

Estrogens are FDA approved for prevention of osteoporosis, but they should only be used short-term in women who need ET for the management of menopausal symptoms such as hot flushes. The risks of long-term ET outweigh the potential bone benefits. 

Guidelines for managing corticosteroid-induced osteoporosis recommend measuring BMD at the beginning of chronic therapy (prednisone 5 mg or more daily or equivalent for at least 6 months) and followup monitoring with DXA in 6 to 12 months. BMD should be measured in patients taking chronic therapy whose baseline values were not obtained. 

This is a proposal to help the clinician to counsel individual women. This process of individualization is crucial and is the best guarantee of a wise use of the different alternatives presently available for an efficient management of the postmenopausal period. Guidelines are only indications of the best choice for a majority of women, but, as health agents of our patients, we have the responsibility of determining how suitable they are for a given woman and introduce the appropriate corrections. In this context SERMs are an early alternative for osteoporosis prevention and treatment that provide an additive protective effect on the breast and are neutral on cardiovascular risk. 

Heparins can be used during pregnancy for the management of thromboembolic disease because they do not cross the placenta. Administration of heparins should be stopped at onset of labour. Low molecular weight heparins are preferred during pregnancy since they pose lower risks of osteoporosis and of heparin-induced thrombocytopenia. 

Ibandronic acid is classified as a bisphosphonate and is used in the management of osteoporosis. It acts selectively on the bone mass, decreasing the osteoclast activity and hence resulting in an increase in bone mass, including the spine cavity. 

Osteoporosis The mainstays of prevention and management of osteoporosis are estrogen and calcium exercise and nutrition may be important adjuncts. 

Bonjour, J. P., and Rizzoli, R. (2002). Bone mass acquisition. In "Osteoporosis Pathophysiology and Clinical Management" (E. S. Orwoll and M. Bliziotes, eds.), pp. 69-82. Humana Press, New Jersey. 

C.Y.C. Pak, K. Sakhaee, V. Piziak, R. Peterson, N.A. Breslau, P. Boyd, J.R. Poindexter, J. Herzog, A. Heard-Sakhaee, S. Haynes, B. Adams-Huet, J.S. Reisch, Slow-release sodium fluoride in the management of postmenopausal osteoporosis. A randomized controlled trial, Ann. Intern. Med. 120 (1994) 625-632. 

Optimal management of the postmenopausal patient requires careful assessment of her symptoms as well as consideration of her age and the presence of (or risks for) cardiovascular disease, osteoporosis, breast cancer, and endometrial cancer. Bearing in mind the effects of the gonadal hormones on each of these disorders, the goals of therapy can then be defined and the risks of therapy assessed and discussed with the patient. 

Androgens also have been used in the management and treatment of agnogenic myeloid metaplasia, aplastic anemia, breast cancer, hereditary angiodema, osteoporosis, paroxysmal nocturnal hemoglobinuria, and sideroblastic anemia. 

Eastell R. Management of corticosteroid-induced osteoporosis. UK Consensus Group Meeting on Osteoporosis. J Intern Med 1995 237(5) 439 17. 

MacLennan AH, Sturdee D. Is hormone therapy still an option for the management of osteoporosis Climacteric 2003 6 89-91. 

Siminoski K, Josse RG. Prevention and management of osteoporosis consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 9. Calcitonin in the treatment of osteoporosis. CMAJ 1996 155(7) 962-5. 

Keam SJ, Plosker GL. Prevention and treatment of osteoporosis in postmenopausal women. Dis Manage Health Outcomes 2004 12 19-37. 

Brown JJ, Zacharin MR. Proposals for prevention and management of steroid-induced osteoporosis in children and adolescents. J Paediatr Child Health. 2005 41 553-557. 

Compston J. How to manage osteoporosis after the menopause. Best Pract Res Clin Rheumatol. 2005 19 1007-1019. 

Gaudio A, Morabito N. Pharmacological management of severe postmenopausal osteoporosis. Drugs Aging. 2005 22 405-417. 

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