Treatment of postmenopausal osteoporosis: an evidence-based approach

I have outlined several therapeutic approaches to the prevention and treatment of PMO. As we enter the 21st century it is certain that even more options will become available for the physician. But, several issues are still unresolved and will require more extensive investigation. These include the following: 1. Employing intermittent (weekly or monthly) oral or intravenous bisphosphonate therapy to treat PMO. 2. Using combination therapy such as an anabolic agent and an anti-resorptive to further reduce fracture risk and enhance BMD. 3. Understanding the various factors which contribute to fracture risk reduction independent of changes in bone mineral density. 4. Defining the role of biochemical markers in predicting fracture risk reduction. 5. Designing new SERMS which combine the best properties of estrogen and estrogen-like products while avoiding significant side effects. What is certain, is that there are now cost effective treatments for this disease. It remains up to the practicing physician to select, based on the existing evidence, treatments most appropriate for the individual patient.