Treatment of postmenopausal osteoporosis

Osteoporosis is a major public health burden. The most devastating outcome of osteoporosis is fracture, which results in increased morbidity and mortality. These fractures most often occur in the vertebrae and indicate an increased risk of future vertebral and hip fractures. Consequently, it is important to identify patients at risk for fracture and to intervene with pharmacologic therapies, lifestyle changes, or both to reduce the frequency of the first or subsequent fracture. Moreover, because osteoporosis is a chronic condition requiring long-term therapy, factors that increase compliance and improve safety and efficacy outcomes should be considered when treatment is selected. The bisphosphonates alendronate and risedronate can substantially reduce the risk of both hip and vertebral fractures. Furthermore, these agents are available in once-weekly formulations that provide patients with a convenient alternative to a daily dosage regimen. Alendronate and the selective estrogen-receptor modulator raloxifene provide considerable vertebral fracture protection after 1 year of treatment, and risedronate markedly reduces the rate of vertebral and nonvertebral fractures after 6 months of treatment. Data suggest that calcitonin-salmon nasal spray also reduces the risk of vertebral, but not nonvertebral, fractures. Raloxifene decreases the risk of nonvertebral fracture, but only in women with severe prevalent vertebral fractures. Although evidence supports the efficacy of hormone therapy, the risks should be carefully considered before treatment is begun. In addition to the antiresorptive therapies, teriparatide is a daily injectable anabolic treatment that is effective in reducing the risk of vertebral and nonvertebral fractures. Therefore, clinicians and patients have several options for reducing the risk of fracture and achieving optimal dosing convenience.