Fracture prevention in postmenopausal osteoporosis: A review of treatment options

Several treatment options are available to reduce the risk of fractures in postmenopausal women with or at risk for osteoporosis. A MEDLINE search was conducted to evaluate antifracture and adverse event data of osteoporosis therapies from trials in postmenopausal women. Among the antiresorptive therapies, the bisphosphonates alendronate and risedronate have demonstrated consistent efficacy in reducing vertebral and nonvertebral fracture risk. Once-weekly alendronate and risedronate produced similar improvements in bone mineral density compared with their once-daily counterparts with similar tolerability. Daily injections of teriparatide resulted in statistically significant reductions in the risk of vertebral and nonvertebral fractures, and trials of ibandronate, raloxifene, and calcitonin nasal spray showed reductions in vertebral fracture risk. Hormone therapy has demonstrated clinical fracture risk reduction; however, safety outcomes from the Women's Health Initiative study have raised concerns regarding long-term use of these preparations. These data can guide clinical decision-making regarding the selection of an osteoporosis therapy. Target Audience: Obstetricians & Gynecologists, Family Physicians. Learning Objectives: After completion of this article, the reader should be able to summarize adverse events data of osteoporosis therapies from trials in postmenopausal women, explain that only a few therapies have shown a consistent efficacy in reducing vertebral and nonvertebral fractures, and state that data from the Women's Health Initiative study have raised concerns regarding long-term use of estrogenprogestin therapy.