Osteoporosis, postmenopausal

The varied clinical uses of estrogens include menstrual disorders, alleviation of menopause, associated symptoms (replacement therapy), osteoporosis, postmenopausal breast cancer and prostatic cancer and hypertrophy, lactation suppression, postcoital contraceptives, oral contraceptives (combined with progestins), estrogen deficiencies unrelated to the menopause, ovarian failure, and hypogenitalism. 

Despite the limitations imposed by the physiology of the skin, several marketed controUed release transdermal dmg dehvery systems are available in the United States for example, scopolamine [51-34-3] for the treatment of motion sickness, nitroglycerin [55-63-0] for angina, estradiol [50-28-2] for the rehef of postmenopausal symptoms and osteoporosis, clonidine [4205-90-7] for the treatment of hypertension, fentanyl [437-38-7] as an analgesic, and nicotine [54-11-5] as an aid to smoking cessation. These systems are designed to dehver dmg for periods of one to seven days. 

Heterocycles as synthetic estrogens in emerging therapies for the prevention or treatment of postmenopausal osteoporosis 99JMC1. 

Summary term for a number of steroid hormones and their precursors with differentiation-inducing activity in many tissues. As regards bone, three components are relevant cholecalciferol ( vitamin D ) 25-hydroxyvi-taminD3 (calcidiol) and 1,25-dihydroxy vitamin D3 (calcitriol). The latter is the biologically active form and increases both intestinal calcium absoiption and bone resorption. Vitamin D preparations are widely used for the treatment of osteoporosis. Daily supplementation with vitamin D reduces bone loss in postmenopausal women and hip fractures in elderly subjects. 

Osteoporosis is a loss of bone density occurring when the loss of bone substance exceeds the rate of bone formation. Bones become porous, brittle, and fragile. Compression fractures of the vertebrae are common. This disorder occurs most often in postmenopausal women, but can occur in men as well. 

Treatment and prevention of postmenopausal osteoporosis glucocorticoid-induced osteoporosis osteoporosis in men Paget s disease... 

The bisphosphonates are used to treat osteoporosis in postmenopausal women, Paget s disease of the bone, and postoperative treatment after total hip replacement (etidronate). 

Osteoporosis Commonly postmenopausal or In other cases Is more gradual and related to age a small number of cases are due to mutations In the COL lA 1 and COL 1A2 genes and possibly In the vitamin D receptor gene (MIM 166710)... 

Studies have demonstrated that treatment with soy or phytoestrogen enriched diets is effective in conserving bone in rodent models of osteoporosis (Anderson and Gamer, 1998 Ishimi et al, 2000 Draper et al, 1997). The mechanism of action of phytoestrogens on bone health is unclear but several mechanisms including inhibition of bone resorption and stimulation of bone formation maybe involved (Fanti etal, 1998 Ishimi e/a/., 1999 Picherit eta/., 2000). Limited data from studies in postmenopausal women have indicated that phytoestrogen supplements have a small, beneficial effect on bone loss in the lumbar spine (Alekel et al, 2000 Potter et al, 1998 Somekawa et al, 2001). 

HARRISON E, ADJEi A, AMEHO c, YAMAMOTO s and KONO s (1998) The effect of soybean protein on bone loss in a rat model of postmenopausal osteoporosis. JNutr Sci Vitaminol 44, 257-68. 

HOLZHERR M L, RETALLACK R W, GUTTERIDGE D H, PRICE R I, FAULKNER D L, WILSON S G, WILL R K, STEWART G O, STUCKEY B G, PRINCE R L, CRIDDLE R A, KENT G N, BHAGAT C I, DHALIWAL S s and JAMROZIK k (2000) Calcium absorption in postmenopausal osteoporosis Benefit of HRT plus calcitriol, but not HRT alone, in both malabsorbers and normal absorbers. Osteoporosis Int 11, 43-51. 

HORIUCHI T, ONOUCHI T, TAKAHASHi M, ITO H and ORIMO H (2000) Effect of soy protein on bone metabolism in postmenopausal Japanese women. Osteoporosis Int 11, 721—4. 

PRINCE R L, SMITH M, DICK I M, PRICE R I, WEBB P G, HENDERSON N K and HARRIS M M (1991) Prevention of postmenopausal osteoporosis. A comparative study of exercise, calciiun supplementation, and hormone-replacement therapy. N Eng J Med 325, 1189-95. 

RIGGS B L, KHOSLA s and MELTON L J, 111 (1998) A Unitary model for involutional osteoporosis estrogen deficiency causes both type 1 and type 11 osteoporosis in postmenopausal women and contributes to bone loss in aging men. J Bone Min Res 13, 16 i-l i. 

It has been shown that in postmenopausal women habitually high intakes of dietary isoflavones are associated with higher bone mineral density (BMD) values at both the spine and hip region (Mei et al, 2001). It is conceivable that an isoflavone-rich diet may help to reverse the state of secondary hyperparathyroidism associated with estrogen withdrawal and hence lower the rate of bone turnover in postmenopausal women, thus reducing the risk of osteoporosis (Valtuena et al, 2003). Phytoestrogens could be used as natural SERMs (Brzezinski and Debi, 1999) and some studies (Setchell, 2001 and refs therein) support such an idea since the molecular targets of... 

In order to get recent advances on the effects of phytoestrogens on hormonal-dependent diseases as well as on human supplementation trials, it might be useful to refer to http //www.venus-ca.org/ (EU-funded project on dietary exposure to phytoestrogens and related compounds and effects on skeletal tissues) http //www.phytos.org (EU-funded project on the prevention of osteoporosis by nutritional phytoestrogens) http //www.phytoprevent.org (EU-funded project on the role of phytoestrogens in the prevention of breast and prostate cancer) and http //www.nutrition.tum.de/isoheart.htm (EU-funded project on cardiovascular health of postmenopausal women). 

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. 

Estrogen currently is indicated for the treatment of moderate to severe vasomotor symptoms and vulvovaginal atrophy associated with menopause. In addition, it is indicated for the prevention of postmenopausal osteoporosis in women with significant risk however, it is recommended that non-estrogen medications receive consideration for long-term use. Oral or transdermal estrogen products should be prescribed at the lowest... 

Postmenopausal osteoporosis is a condition that affects millions of women and is characterized by low bone mass with microarchitectural deterioration of bone tissue that can... 

BMD will increase and the risk of fractures will decrease in women taking HRT. However, when therapy is discontinued, a decline in BMD will resume at the same rate as in women not on HRT. Therefore, therapy for osteoporosis prevention should be considered long term. Since HRT should be maintained only for the short term, alternative therapies such as bisphosphonates or raloxifene should be considered as first-line therapy for the prevention of postmenopausal osteoporosis, in addition to appropriate doses of calcium and vitamin D. Because of the risks associated with HRT, it should not be prescribed solely for the prevention of osteoporosis. 

All postmenopausal women with a personal history of osteoporotic fracture and/or low bone mineral density with risk factors for osteoporosis should receive treatment for osteoporosis. 

Bisphosphonates are hrst-line therapy for postmenopausal osteoporosis owing to their established efficacy in preventing hip and vertebral fractures. 

Osteoporosis is a common and often silent disorder associated with significant morbidity and mortality and reduced quality of life. It is associated with increased risk and rates of bone fracture and is responsible for over 1.5 million fractures in the United States annually, resulting in direct health care costs of over 17 billion.1 As the population ages, these numbers are expected to increase. It is estimated that postmenopausal Caucasian women have a 50% lifetime chance of developing an osteoporosis-related fracture.1 Common sites of fracture include the spine, hip, and wrist, although almost all sites can be affected. Only a fraction of patients with osteoporosis receive optimal treatment. 

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