title: Prevention of osteoporosis: one step forward, two steps back.
abstract: For many years, hormone replacement therapy (HRT) was the mainstay for osteoporosis prevention in postmenopausal women until a large randomized clinical trial raised serious safety concerns. This resulted in a big drop in HRT use and its demotion by regulatory authorities to second-line treatment. Many clinicians now feel that HRT is not safe to use, and recommend various alternatives for the treatment of osteoporosis. But how effective are these alternative therapies, are they any safer than HRT, and how do their costs compare? This review questions the validity of the safety concerns about HRT, and highlights the safety concerns about alternative therapies. It concludes that HRT is as safe as the other treatment options, and its efficacy and low cost demand that it be restored as a first-line treatment for the prevention of postmenopausal osteoporosis. Other therapies are available for use in osteoporosis, and the bisphosphonates are particularly effective for the treatment of the established disease. However, they must be used selectively and with caution, and are best restricted to those patients who are elderly or have severe disease. New treatments are emerging, but again caution must be taken until any long-term adverse effects have been identified.
authors: National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, UK. j.stevenson@imperial.ac.uk
authors: John C
authors: JC
authors: Stevenson
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002116:Calcitonin / Q000009:adverse effects / Q000627:therapeutic use; D002118:Calcium / Q000009:adverse effects / Q000627:therapeutic use; D000069448:Denosumab; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D020847:Estrogen Receptor Modulators / Q000009:adverse effects / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D009652:Norpregnenes / Q000009:adverse effects / Q000627:therapeutic use; D009942:Organometallic Compounds / Q000009:adverse effects / Q000627:therapeutic use; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D019379:Teriparatide / Q000009:adverse effects / Q000627:therapeutic use; D013876:Thiophenes / Q000009:adverse effects / Q000627:therapeutic use; D014807:Vitamin D / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D020847:Estrogen Receptor Modulators; D009652:Norpregnenes; D009942:Organometallic Compounds; D013876:Thiophenes; C081587:strontium ranelate; D019379:Teriparatide; D014807:Vitamin D; D000069448:Denosumab; D002116:Calcitonin; C027385:tibolone; D002118:Calcium