Osteoporosis prevention

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. 

In order to prevent certain risk factors and maximize peak bone mass, efforts must be directed toward osteoporosis prevention at an early age. 

Eichner SF, Lloyd KB, Timpe EM. Comparing therapies for postmenopausal osteoporosis prevention and treatment. Ann Pharmacother 2003 37 711-724. 

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. The Journal of the American Medical Association,... 

Lanham-New S. 2006. Fruits and vegetables the unexpected natural answer to the question of osteoporosis prevention Am J Clin Nutr 83 1254-1255. 

TABLE 31-2 Estrogen for Treatment of Menopausal Symptoms and Osteoporosis Prevention ... 

The benefits of hormonal therapies for osteoporosis prevention are discussed in Chap. 3. Hormone therapy should be considered for osteoporosis prevention only in women at significant risk for osteoporosis who cannot take nonestrogen regimens. 

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. 

Osteoporosis prevention - Administer cyclically (eg, 23 days on and 5 days off) 0.5 mg/day as soon as possible after menopause. Adjust dosage if necessary to control concurrent menopausal symptoms. 

In women with an intact uterus for the treatment of moderate to severe vasomotor symptoms associated with menopause treatment of vulval and vaginal atrophy Femhrt and CHmaraPro excluded) osteoporosis prevention CombiPatch and ClimaraPro excluded) treatment of hypoestrogenism caused by hypogonadism, castration, or primary ovarian failure CombiPatch only). 

Osteoporosis, prevention, and treatment Prevention and treatment of osteoporosis in postmenopausal women. 

Vitamin D-resistant rickets PO 250-1,500 meg/day (with phosphate supplements). Osteoporosis prevention PO 400-600 units/day. Maximum 2,000 units/day. 

Kwiatkowska, E. (2007). Phytoestrogens in osteoporosis prevention. Przegl. Menopauzalny 6, 306-309. 

Postmenopausal osteoporosis—prevention and treatment Paget s disease having alkaline phosphatase at least two times the upper limit of normal, or in patients who are symptomatic or at risk for further complications... 

Cohen FJ, Lu Y. Characterization of hot flashes reported by healthy postmenopausal women receiving raloxifene or placebo during osteoporosis prevention trials. Maturitas 2000 34(l) 65-73. 

When thyroid therapy is used not only to replace deficiency but also to prevent the growth of remnants of a differentiated thyroid carcinoma, a suppressive dosage is used, aiming at T4 concentrations in the high reference range and an undetectable TSH concentration or at least one that is below the lower end of the reference range, as measured by two-sided assays. Such therapy is warranted because of its long-term safety, efficacy, and tolerance, but some additional therapy for osteoporosis prevention should be considered. 

Conjugated estrogens Premarin Estrogen replacement, antineoplastic, prevention of osteoporosis, prevention of abnormal uterine bleeding... 

Raloxifene (1) i Evista Mixed Agonist/ Antagonist Osteoporosis prevention/tre almenl/ Invasive breast cancer risk reduction Eli Lilly Approved 1997/1999/2 007 (US)... 

Willhite SL, Goebel SR, Scoggin JA (1998) Raloxifene provides an alternative for osteoporosis prevention. Ann Pharmacother 32 834-837... 

Shearer MJ (1997) The roles of vitamins D and K in bone health and osteoporosis prevention. Proceedings of the Nutrition Society 56, 915-937. 

Trans-resveratrol (43) extract prepared from Polygonum cuspidatum (Polygonaceae) showed reduction of reperfusion-induced ventricular fibrillation in vitro) from its control value of 83% to 75% when rats were orally treated with 50mg/kg and lOOmg/kg dose. Thus, it can be a potential alternative to conventional HRT for cardioprotection and osteoporosis prevention [38]. 

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