This document discusses trends in the prevention and treatment of postmenopausal osteoporosis. It first focuses on identifying risk factors and modifying lifestyle to reduce risks. If needed, pharmacologic therapy options approved by the FDA include estrogens, bisphosphonates, selective estrogen receptor modulators, calcitonin, and parathyroid hormone. Studies show bisphosphonates and parathyroid hormone are most effective at reducing vertebral and non-vertebral fractures. The management of osteoporosis depends on a patient's bone mineral density and fracture risk, with lifestyle changes and bisphosphonates often used for prevention and raloxifene, parathyroid hormone, or calcitonin for treatment.

1. Osteoporosis
New Trends in
Prevention and Treatment
DR. RABI NARAYAN SATAPATHY
ASST.PROFESSOR
DEPT. OF OBST.& GYNAECOLOGY
SCB MEDICAL COLLEGE, CUTTACK
MOB-09861281510
EMAIL-drrabisatpathy@gmail.com

2. The management of
postmenopausal osteoporosis
first focuses on identifying the
woman’s risk factors,
then selecting measures that will
reduce modifiable risk factors
through lifestyle changes and, if
indicated, pharmacologic therapy.

3. If pharmacologic therapy is indicated
• FDA-approved options are:
• Estrogens (prevention only) according
FDA new statement.
• Bisphosphonates and Selective estrogen-
receptor modulators (prevention and
treatment),
• Calcitonin (treatment only).
• PTH

4. Anti fracture efficacy of the most frequently used treatment of
postmenopausal osteoporosis in addition to the effects of
calcium or vitamin D supplementation, or both, as derived
from placebo controlled randomized trials.
DRUG Vertebral # Non Vertebral #
Alendronate +++ ++
Calcitonin + 0
Etidronate + 0
Fluoride ± -
HRT + 0
PTH +++ ++
Raloxifene +++ 0
Risedronate +++ ++
Vitamin D derivatives ± 0
Delmas, The Lancet 359:2018-2026, 2002

5. Magnitude of the Treatment Effect on
Vertebral and Non Vertebral Fractures
in Postmenopausal Woman with Osteoporosis
CRANNEY A et al . ENDOCRINE REV 2002, 23(4);570 - 578
CA=Calcitonon,VIT D=Vitamin D,ALN=Alendronate ,RIS=Risedronate ,RLX=Raloxifen,SCT=Calcitonin,FLU=Fluoride,ETD =Etidronate
0.2
0
0.4
0.6
0.8
1
1.2
1.4
1.6
RelativeRiskforFractures
CA
n=576
VIT D
n=1,130
ALN
n=9,360
RIS
n=2,604
RLX
n=6,828
HRT
n=3,117
SCT
n=1,108
FLU
n=646
SPINE#
NONSPINE#
P < 0.05
P=0.05
ETD
n=1,076

6. Osteoporosis
prevention
T-score –1 to –2.5
Osteoporosis
treatment with or
without
previous fracture
T-score < -2.5
Osteoporosis treatment
with multiple fractures
and at risk for hip fracture
50 55 60 65 70 75 80 85
90
Raloxifene
Age (years)
HRT=hormone replacement therapy
HRT
Therapeutic Management of Postmenopausal
Osteoporosis
PT
H
Short-term
vasomotor
symptom
management
Bisphosphonate
s

7. Raloxifene
PTH
CalcitoninHRTHRT
HRTHRT
During Hot
Flashes
Post Vasomotor Symptoms
Pre fracture
Post Fracture
Risk
of Fracture
AGE
At Risk/Osteopenia Osteoporosis Severe OsteoporosisSTAGE
LowerHigher
-2.5BMD (T-score)
Bisphosphonates
Osteoporosis Therapy AlgorithmOsteoporosis Therapy Algorithm
Postmenopausal WomenPostmenopausal Women