Osteoporosis prophylaxis

Osteoporosis prophylaxis in postmenopausal females PO 0.5 mg/day cyclically (3 weeks on, 1 week off). Transdermal (Climara) Initially, 0.025 mg weekly, adjust dose as needed. Transdermal (Alora, Vivelle, Vivelle-Dot) Initially, 0.025 mg patch twice weekly, adjust dose as needed. Transdermal (Estraderm) 0.05 mg twice weekly. Transdermal (Menostar) 1 mg weekly. 

It is indicated in vasomotor symptoms in estrogen deficiency and osteoporosis prophylaxis. 

Hart SR, Green B. Osteoporosis prophylaxis during corticosteroid treatment failure to prescribe. Postgrad Med J 2002 78(918) 242-3. 

Alendronic acid and Calcichew D3 Forte can be withheld prior to the procedure as they are for osteoporosis prophylaxis. 

Ferguson N (2000) Osteoporosis-prophylaxis and treatment. Hospital Pharmacist 7 69-71. 

R. R Heaney Bone mass, bone loss and osteoporosis prophylaxis. Annals of Internal Medicine 128, 313 (1998). 

In a retrospective audit of 105 patients (38 men and 67 women, over 18 years of age) in a tertiary care center in India, 56 % had at least one documented intervention related to osteoporosis prevention (calcium, vitamin D, bisphosphonates, or a bone mineral density study) [17. Only three patients received bisphosphonates for osteoporosis prophylaxis. There was poor pretherapeutic risk assessment, absence of instructions regarding preventive measures, inappropriate investigation for the presence of osteoporosis, and unacceptable failure to use bone protective agents. 

This combination product is on example of a combined hormone replacement therapy that increases the risk of stroke slightly and, with long-term use, increases the risk of ovarian cancer slightly. Hormone replacement therapy alleviates symptoms of menopause and can be used as a prophylaxis of osteoporosis. 

Indications for estrogens and pro-gestins include hormonal contraception (p. 256), hormone replacement, as in postmenopausal women for prophylaxis of osteoporosis bleeding anomalies, menstrual complaints. Concerning adverse effects, see p. 256. 

Once bone loss is sufficient to result in a compression fracture, pharmacological therapy is much less effective. However, even after fractures have occurred, the use of the bisphosphonates and rPTH has been shown to increase bone densities and reduce the rate of subsequent fractures. Nasal calcitonin (200 units daily) is effective in promoting fracture healing and also exhibits an analgesic effect by reducing pain in persons with acute lumbar compression fractures. Whatever compound is used for prophylaxis or treatment of osteoporosis, calcium and Ds supplementation are required for maximum benefit. 

It is indicated in prophylaxis and treatment of rickets, postmenopausal osteoporosis, Fanconi syndrome and hypoparathyroidism. 

Fluoride is well established as effective for the prophylaxis of dental caries and has been under investigation for the treatment of osteoporosis. Both therapeutic applications originated from epidemiologic observations that subjects living in areas with naturally fluoridated water (1-2 ppm) had less dental caries and fewer vertebral compression fractures than subjects living in nonfluoridated water areas. Fluoride is accumulated by bones and teeth, where it may stabilize the... 

Raloxifene is approved for use in the treatment and prophylaxis of osteoporosis. As shown in the table opposite, it has other beneficial as well as adverse effects. 

Advanced breast cancer Questionable therapy Estradiol and prophylaxis of osteoporosis in 1 postmenopause ... 

Owing to the reduction in oestrogen levels during the menopause, an increase in bone loss is seen. However, HRT is generally not recommended as first-line therapy for the prophylaxis or treatment of postmenopausal osteoporosis. It should only be used where other therapies are contraindicated, not tolerated, or there is a lack of response. In chronic liver disease HRT may be used first line due to intolerance of other agents, for example bisphosphonates. 

The goal of CNS prophylaxis is to eradicate undetectable leukemic cells from the CNS. Leukemic meningitis is more easily prevented than treated. Once CNS relapse has occnrred, patients are at increased risk of bone marrow relapse and death from refractory leukemia. Initial trials in childhood ALL in the 1960s established craniospinal irradiation as the standard for prevention of CNS relapse." However, this approach was associated with long-term seqnelae including neuropsychological deficits, precocious puberty, osteoporosis, thyroid dysfunction, an increased incidence of brain tumors, short stature, and obesity. Subseqnent trials have demonstrated that irradiation may be replaced by freqnent administration of intrathecal chemotherapy in most children with ALL."... 

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