Comparing therapies for postmenopausal osteoporosis prevention and treatment.
OBJECTIVE
To review the literature concerning the efficacy of calcium, hormone replacement therapy (HRT), bisphosphonates, selective estrogen receptor modulators, and calcitonin in the prevention and treatment of postmenopausal osteoporosis.


METHODS
Articles were identified through searches of the MEDLINE (1966-July 2002), EMBASE (1980-July 2002), and International Pharmaceutical Abstracts (1970-July 2002) databases using the key words osteoporosis, postmenopausal, fracture, calcium, vitamin D, hormone replacement therapy, bisphosphonates, alendronate, risedronate, raloxifene, and calcitonin. Additional references were located through review of the bibliographies of the articles cited. Searches were not limited by time restriction, language, or human subject.


METHODS
Experimental and observational studies of the use of calcium and antiresorptive therapies for the prevention and treatment of postmenopausal osteoporosis were selected. Articles evaluating bone mineral density (BMD) or fracture efficacy were included in this review.


RESULTS
HRT, bisphosphonates, raloxifene, and calcitonin have demonstrated stabilization of and improvement in BMD. Randomized clinical trials have shown fracture risk reduction with bisphosphonates, raloxifene, HRT, calcium, and calcitonin. The largest risk reductions have been reported with use of bisphosphonates in several trials.


CONCLUSIONS
Several therapeutic options with well-documented improvements in BMD and reductions in fracture risk are available to women for the prevention and treatment of postmenopausal osteoporosis.
Eichner
Samantha F
SF
College of Pharmacy, University of Tennessee, Memphis, TN, USA. seichner@utmem.edu
Lloyd
Kimberly B
KB
Timpe
Erin M
EM
D002116:Calcitonin / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy* / Q000517:prevention & control*; D017698:Postmenopause; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use
D004164:Diphosphonates; D020845:Selective Estrogen Receptor Modulators; D002116:Calcitonin; D002118:Calcium