[Therapeutic strategies for osteoporosis]

Therapeutic strategy in osteoporosis should rely on the results of good quality randomized controlled trials. When a fracture has already occurred, first line treatments are alendronate or hormone replacement therapy. Alternatives are cyclical etidronate, or calcitonin in some countries. General measures, such as adequate nutrition and calcium and vitamin D intake, and prevention of falls should be associated to drugs. When there is no history of fracture, the decision will rely on the existence of clinical risk factors and the bone density. Women with a densitometric osteoporosis will be treated as those who have already fractured. Those who have osteopenia can receive hormone replacement therapy, alendronate or raloxifene. No treatment is indicated in women who have normal bone density.