[Therapy of postmenopausal osteoporosis]

The therapy of postmenopausal osteoporosis is based on a few comprehensible assumptions. High bone resorption should be reduced by treatment with bisphosphonates, raloxifene or seldom with calcitonins. After reduction of high bone turnover and in low bone turnover situations, an osteoinductive combination therapy should be started, inducing collagen type I with parathyroid hormone or fluorides. This collagen can then be mineralized by calcium, vitamin D, and vitamin D metabolites. In addition, bone resorption should be reduced during menopause with estrogens and gestagens, in the case of a receptor-positive breast cancer with tamoxifen, and after menopause with raloxifene or a bisphosphonate. In elderly patients a depletion of vitamin D often induces an osteoporomalacia instead of an osteoporosis. In this situation, mineralization of the osteoid by calcium and vitamin D is sufficient for therapy. A daily osteoporosis gymnastic program is required and physical activity should be enhanced to increase muscle mass because bone adapts to the individual situation.