Postmenopausal women osteoporosis

Osteoporosis is a condition of skeletal fragility due to progressive loss of bone mass. It occurs in the elderly of both sexes, but is most pronounced in postmenopausal women. Osteoporosis is characterized by frequent bone fractures, which are a major cause of disability among the elderly. Figure 43.1 showns changes in bone morphology seen in osteoporosis. 

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. 

Although estrogen replacement therapy at menopause can prevent bone loss and cardiovascular disease, there is evidence that estrogens are associated with an increased risk of breast cancer as well as endometrial cancer(Gambrell, 1994), which thus seriously limits the use of estrogen replacement therapy. The ideal compound for women s health should be one able to decrease the risk of the most important causes of morbidity and mortality in women, namely breast cancer, uterine cancer, osteoporosis, bone fractures, and cardiovascular disease. Heart disease is, in fact, the leading cause of death in postmenopausal women (Lerner and Kannel, 1986). This ideal compound should also have an excellent safety profile to ensure compliance over 20 to 40 years of a woman s life. 

Skin Toxic epidermal necrolysis has been attributed to strontium ranelate 2 g/day in a 72-year-old Chinese woman with postmenopausal osteoporosis. The lesions resolved after treatment with intravenous immunoglobulin 1 g/kg/day for 3 days [53 ]. 

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