[Treatment of postmenopausal osteoporosis in 2004]

Major improvements have been observed, during the last ten years, in the management of postmenopausal osteoporosis. The most significant benefits have been obtained through the availability of new medications which have demonstrated their anti-fracture efficacy in the course of well conducted, scientifically sound studies. Due to the pharmacological properties of these new medications, treatment of osteoporosis can now be tailored to the needs of each and every single postmenopausal woman. Calcium supplementation (500 mg/day) should be offered to all post menopausal women unless dietary records show a sufficient intake. On the grounds of the high prevalence of low serum vitamin D levels in the ederly Belgian population, the systematic use of a calcium-vitamin D combination, after the age of 65 years, appears to be justified. Raloxifene is an interesting option for women with low mineral density or prevalent vertebral fractures. This molecule has demonstrated unequivocal anti-fracture efficacy at the level of the spine and is also caracterized by a beneficial effect on non-spinal fractures, in high risk women. Bisphosphonates (alendronate and risedronate) have shown the anti-fracture efficacy at the level of the axial and appendicular skeleton. The availability of a weekly formulation improves their compliance, notwithstanding the constrains related to the potential upper gastro-intestinal toxicity of these compounds. Bisphosphonates appear to be the first-line choice for patients with more severe osteoporosis and high risk to develop hip fractures. Teriparatide (1-34 Fragment of parathyroid hormone) is a new pharmacological option, oriented, mainly if not exclusively because of its parenteral administration and high cost, to patients with severe osteoporosis (low bone density and prevalent vertebral fracture(s). Strontium ranelate offers an anti-fracture efficacy at all skeleton sites and an oustanding overall tolerance and may play a main role in the future management of osteoporosis.