Preventing osteoporosis in symptomatic postmenopausal women

Osteoporosis is a common postmenopausal disease that has a substantial impact on the quality of life of older women and is associated with significant morbidity and mortality. There are various options for preventing osteoporosis in postmenopausal women, and all are associated with differing benefit-risk profiles. Estrogen therapy (in hysterectomized women) and estrogen/progestogen therapy (in nonhysterectomized women) are the most effective treatments available for the relief of vasomotor and urogenital symptoms in postmenopausal women and provide significant protection against osteoporotic fractures. Selective estrogen receptor modulators reduce bone loss and prevent vertebral fractures without endometrial or breast stimulation. Raloxifene, the only selective estrogen receptor modulator approved for osteoporosis prevention and treatment, significantly reduces vertebral but not nonvertebral or hip fractures. Bisphosphonates prevent bone loss and vertebral fractures; however, not all bisphosphonates have been shown to prevent nonvertebral fractures. Selective estrogen receptor modulators and bisphosphonates are not effective for menopausal symptoms. Hormone therapy should be considered as first-line therapy for preventing bone loss and fractures in early postmenopausal women who are symptomatic; other options include selective estrogen receptor modulators and bisphosphonates, especially in older, nonsymptomatic women. Future therapies are likely to include newer selective estrogen receptor modulators, combinations of estrogen with selective estrogen receptor modulators, and denosumab.