Risk of fracture and treatment to prevent osteoporosis-related fracture in postmenopausal women. A review.
OBJECTIVE
To review the antifracture efficacy of pharmacologic therapy approved by the U.S. Food and Drug Administration for the treatment of postmenopausal osteoporosis.


METHODS
For this literature review, published trials of antiresorptive therapy with the bisphosphonates risedronate and alendronate, the selective estrogen receptor modulator raloxifene and calcitonin were reviewed; hormone replacement therapy was not included as this modality is not indicated for treatment of osteoporosis.


RESULTS
In controlled trials of postmenopausal women with osteoporosis, risedronate reduced the incidence of clinically evident vertebral fracture after 6 months of therapy and radiographically detected vertebral and nonvertebral fracture after 1 year. In similar trials, alendronate also reduced the risk of clinical vertebral fractures in 1 year. Risedronate and alendronate were both well tolerated, but some trials of alendronate were closed to women with recent upper gastrointestinal disease. In a large, controlled trial, raloxifene demonstrated a significant reduction in the risk of clinical vertebral fracture but not in the risk of nonvertebral fracture. Raloxifene is also associated with a 3-fold increased risk of thromboembolism. Calcitonin reduced the incidence of vertebral fracture, but there are no conclusive data on prevention of nonvertebral fracture.


CONCLUSIONS
Antiresorptive therapy can reduce the risk of osteoporotic vertebral fracture. The bisphosphonates are also effective in reducing the risk of hip fracture in women with osteoporosis.
Martens
Mark G
MG
Department of Gynecology and Obstetrics, University of Oklahoma, 1145 South Utica, Suite 600, Tulsa, OK 74104-4070, USA. mark-martens@ouhsc.edu
D000368:Aged; D019386:Alendronate / Q000494:pharmacology*; D002116:Calcitonin / Q000494:pharmacology*; D002986:Clinical Trials as Topic; D004164:Diphosphonates / Q000494:pharmacology*; D004965:Estrogen Antagonists / Q000494:pharmacology*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000188:drug therapy*; D017698:Postmenopause; D020849:Raloxifene Hydrochloride / Q000494:pharmacology*; D012307:Risk Factors
D004164:Diphosphonates; D004965:Estrogen Antagonists; D020849:Raloxifene Hydrochloride; D002116:Calcitonin; D019386:Alendronate