Osteoporosis prevention and treatment

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

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

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... 

In most studies, patients with rheumatoid arthritis have lower BMD and more fractures than do age-matched controls.Common disease pathways, inclnding proinflammatory cytokines and the OPG/RANK/RANKL system, may be responsible along with increased glucocorticoid use, hypogonadism, decreased activity, and increased fall risk. Patients taking glucocorticoids should be managed with calcium and vitamin D snpplementation plus a bisphosphonate. Otherwise, standard osteoporosis prevention and treatment interventions are recommended. 

In the vitamin D deficiency disease rickets, the bones of children are undermineralized as a result of poor absorption of calcium. Similar problems occur in adolescents who are deficient during their growth spurt. Osteomalacia in adults results from demineralization of bone in women who have little exposure to sunlight, often after several pregnancies. Although vitamin D is essential for prevention and treatment of osteomalacia in the elderly, there is little evidence that it is beneficial in treating osteoporosis. 

Adequate calcium and vitamin D intake is essential in the prevention and treatment of osteoporosis. Calcium and vitamin D supplements to meet requirements should be added to all drug therapy regimens for osteoporosis. 

AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis ... 

National Osteoporosis Foundation. Physician s Guide to Prevention and Treatment of Osteoporosis. Washington National Osteoporosis Foundation 2003. 

Alendronate, risedronate, and oral ibandronate are FDA approved for prevention and treatment of postmenopausal osteoporosis. IV ibandronate and zoledronic acid are indicated only for treatment of postmenopausal women. Risedronate and alendronate are also approved for male and glucocorticoid-induced osteoporosis. 

Raloxifene is an estrogen agonist on bone but an antagonist on the breast and uterus. It is approved for prevention and treatment of postmenopausal osteoporosis. Other estrogen agonists/antagonists maybe approved soon (e.g., bazedoxifene, lasofoxifene). 

The second group of SERMs includes drugs such as raloxifene (previously named keoxifene), arzoxifene (Fig. 2.2), and LY-117018. Raloxifene was initially designed as a drug to treat breast cancer, but its clinical development was later focused on prevention and treatment of postmenopausal osteoporosis,... 

The novel SERMs, which include bazedoxifene and ospemifene (also known as deaminohydroxy-toremifene), are being investigated for the prevention and treatment of osteoporosis in post-menopausal women in phase III clinical trials [151,165]. The non-steroidal SERM lasofoxifene (CP-336156) [151], currently under consideration by the Food and Drug Administration for both prevention of osteoporosis and urogenital atrophy, may have potential for... 

A variety of diseases can affect bone and its structure. Paget s disease, for example, is a disorder arising from abnormal osteoclasts, characterized by exeessive bone resorption followed by replacement of the normal mineralized bone with structurally weak, poorly mineralized tissue. However, the most important bone disease is osteoporosis. This is a skeletal bone disease characterized hy microarchitectural deterioration of bony tissue and loss of bone mass, yielding increased susceptibility to bone fracture and bone fragility. In the United States, osteoporosis results in 1.5 million hone fractures annually, with 250,000 of these being hip fractures that sometimes ultimately culminate in patient death. There is a variety of therapies for the prevention and treatment of osteoporosis. 

Estrogen have been used in prevention and treatment of osteoporosis. 

The role of estrogens in the prevention and treatment of osteoporosis has been carefully studied (see Chapter 42). The amount of bone present in the body is maximal in the young active adult in the third decade of life and begins to decline more rapidly in middle age in both men and women. The development of osteoporosis also depends on the amount of bone present at the start of this process, on vitamin D and calcium intake, and on the degree of physical activity. The risk of osteoporosis is highest in smokers who are thin, Caucasian, and inactive and have a low calcium intake and a strong family history of osteoporosis. Depression also is a major risk factor for development of osteoporosis in women. 

Estrogens are routinely prescribed to post-menopausal women to prevent the development and exacerbation of osteoporosis, because it can increase bone density and reduce fractures. Estradiol (14) or conjugated estrogens are typical agents used for the prevention and treatment of osteoporosis. 

Goldstein MF, Fallon JJ Jr, Haming R. Chronic glucocorticoid therapy-induced osteoporosis in patients with obstructive lung disease. Chest 1999 116(6) l 733—49. Yosipovitch G, Hoon TS, Leok GC. Suggested rationale for prevention and treatment of glucocorticoid-induced bone loss in dermatologic patients. Arch Dermatol 2001 137(4) 477-81. 

American College of Rheumatology Task Force on Osteoporosis Guidelines. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum 1996 39(11) 1791-801. 

Miller E. Therapeutic options an evidence-based approach to prevention and treatment of osteoporosis. Int J Fertil Women s Med 2003 48 122-6. 

Albertazzi P, Purdie DW. Oestrogen and selective oestrogen receptor modulators (SERMs) current roles in the prevention and treatment of osteoporosis. Best Pract Res Clin Rheumatol 2001 15(3) 451-68. 

Olszynski WP, Davison KS, Adachi JD, Brown JP, Cummings SR, Hanley DA, Harris ST, Hodsman AB, Kendler D, McClumg MR, Miller PD, Yuen CK. Osteoporosis in men epidemiology, diagnosis, prevention and treatment. ClinTher 2004 26 15-28. 

Recker RR, Barger-Lux J. Risedronate for prevention and treatment of osteoporosis in postmenopausal women. Expert Opin Pharmacother. 2005 6 465-477. 

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