[Current therapeutic means].
VARIOUS THERAPEUTIC POSSIBILITIES: Treatment of osteoporosis has greatly progressed over the past few years and, in parallel with hormone replacement therapy (HRT), new drugs (2nd and 3rd generation bisphosphonates and raloxifen) are now available, not only for primary prevention but also for secondary prevention of fractures. WHAT INDICATIONS?: The anti-fracture efficacy that has been demonstrated in large clinical trials, conducted according to the requirements of modern methodology, only appear patent in women at "high risk" for osteoporosis, i.e., those presenting a t-score < -2.5 and a prevalent fracture (particularly vertebral crushing), situation which is relatively rare at the onset of the menopause.


CONCLUSIONS
The initiation of such treatment in a women approaching the menopause should only be considered after prior measurement of her bone density, using a validated technique, measurement that is not always officially recognized by our Health Authorities. This problem, together with the varying conditions of prescription and reimbursement, explain some of the problems encountered in the use of these new therapeutics, notably in women at high risk of osteoporosis, who have not yet presented a fracture due to their bone fragility.
Trémollières
Florence
F
Unité Ménopause et Maladies Osseuses Métaboliques, service d'Endocrinologie, CHU Rangueil, 31403 Toulouse. tremollieres.f@chu-toulouse.fr
Pouillès
Jean-Michel
JM
Ribot
Claude
C
D015519:Bone Density; D004965:Estrogen Antagonists / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000517:prevention & control / Q000628:therapy*; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D015203:Reproducibility of Results
D004965:Estrogen Antagonists; D020849:Raloxifene Hydrochloride