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    Osteoporosis in postmenopausal women: Therapy options across a wide range of risk for fracture



    Osteoporosis is a highly prevalent skeletal disorder characterized by compromised bone strength predisposing individuals to an increased risk of fractures. Fractures related to osteoporosis are frequently associated with chronic pain and decreased quality of life, as well as significant morbidity and mortality. Postmenopausal women are at higher risk for developing osteoporosis and osteoporosis-related fractures. Osteoporotic fractures are commonly asymptomatic, necessitating a need for proactive screening, diagnostic testing, and more importantly, therapeutic intervention that will rapidly reduce the risk of fractures in at-risk patients. Current pharmacologic prevention and treatment options for osteoporosis include antiresorptive therapies (alendronate, risedronate, ibandronate, raloxifene, hormone therapy, and calcitonin) and the anabolic agent teriparatide.

    Miller RG. Osteoporosis in postmenopausal women: Therapy options across a wide range of risk for fracture. Geriatrics 2006; 61(Jan):24-30.

    Key words: osteoporosis • osteoporotic fractures • postmenopausal • bisphosphonates

    Drugs discussed: alendronate/Fosamax • calcitonin/Miacalcin • ibandronate/Boniva • raloxifene/Evista • risedronate/Actonel • teriparatide/Forteo









    Osteoporosis is a highly prevalent skeletal disorder characterized by compromised bone strength predisposing individuals to an increased risk of fractures. Nearly 30 million women in the United States have osteoporosis or low bone mineral density. Illustration for Geriatrics by Alexandra Baker
    Osteoporosis is a highly prevalent skeletal disorder characterized by compromised bone strength predisposing individuals to an increased risk of fractures.1 Approximately 8 million women in the United States have osteoporosis and 22 million have low bone mineral density (BMD) of the hip.1 Twenty percent of non-Hispanic white and Asian women age 50 and older are estimated to have osteoporosis and 52% are estimated to have low bone mass. The corresponding figures for non-Hispanic black women are 5% and 35% (for osteoporosis and low bone mass, respectively); these figures are slightly higher in Hispanic women (10% and 49%). One out of every 2 white women will experience an osteoporosis-related fracture (ie, a fracture in which the associated trauma would not have resulted in a fracture of normal bone; also called a fragility fracture). Moreover, after sustaining a vertebral fracture, risk of subsequent fracture increases 5-fold within just 1 year.2 Osteoporotic fractures are painful and can be assoicated with decreased quality of life, as well as significant morbidity and mortality. Those who experience fractures often have some degree of permanent disability, and in the United States, up to 25% of patients who experience a hip fracture may be transferred to a nursing home.3

    This review examines how women at high risk for osteoporotic fracture can benefit from an osteoporosis therapy with a rapid onset of antifracture efficacy.

    Risk factors/need for protection


    Table 1 Osteoporosis and fragility fracture risk factors in postmenopausal women*
    Postmenopausal women are at risk for developing osteoporosis and related fractures. Risk factors for osteoporotic fractures include low BMD, prevalent fracture, increasing age, low body weight, height loss, certain medical disorders (eg, inflammatory bowel disease, rheumatoid arthritis, hyperthyroidism, celiac disease), and history of fracture in a first-degree relative (see Table 1).3 In addition to menopause, conditions or procedures associated with accelerated bone loss include use of some medications (eg, glucocorticoids, anticonvulsants such as phenytoin and phenobarbital, and cytotoxic drugs), transplantation, and immobilization (due to disease or trauma).3



    Osteoporosis is a highly prevalent skeletal disorder characterized by compromised bone strength predisposing individuals to an increased risk of fractures. Fractures related to osteoporosis are frequently associated with chronic pain and decreased quality of life, as well as significant morbidity and mortality. Postmenopausal women are at higher risk for developing osteoporosis and osteoporosis-related fractures. Osteoporotic fractures are commonly asymptomatic, necessitating a need for proactive screening, diagnostic testing, and more importantly, therapeutic intervention that will rapidly reduce the risk of fractures in at-risk patients. Current pharmacologic prevention and treatment options for osteoporosis include antiresorptive therapies (alendronate, risedronate, ibandronate, raloxifene, hormone therapy, and calcitonin) and the anabolic agent teriparatide.

    Miller RG. Osteoporosis in postmenopausal women: Therapy options across a wide range of risk for fracture. Geriatrics 2006; 61(Jan):24-30.

    Key words: osteoporosis • osteoporotic fractures • postmenopausal • bisphosphonates

    Drugs discussed: alendronate/Fosamax • calcitonin/Miacalcin • ibandronate/Boniva • raloxifene/Evista • risedronate/Actonel • teriparatide/Forteo









    Osteoporosis is a highly prevalent skeletal disorder characterized by compromised bone strength predisposing individuals to an increased risk of fractures. Nearly 30 million women in the United States have osteoporosis or low bone mineral density. Illustration for Geriatrics by Alexandra Baker
    Osteoporosis is a highly prevalent skeletal disorder characterized by compromised bone strength predisposing individuals to an increased risk of fractures.1 Approximately 8 million women in the United States have osteoporosis and 22 million have low bone mineral density (BMD) of the hip.1 Twenty percent of non-Hispanic white and Asian women age 50 and older are estimated to have osteoporosis and 52% are estimated to have low bone mass. The corresponding figures for non-Hispanic black women are 5% and 35% (for osteoporosis and low bone mass, respectively); these figures are slightly higher in Hispanic women (10% and 49%). One out of every 2 white women will experience an osteoporosis-related fracture (ie, a fracture in which the associated trauma would not have resulted in a fracture of normal bone; also called a fragility fracture). Moreover, after sustaining a vertebral fracture, risk of subsequent fracture increases 5-fold within just 1 year.2 Osteoporotic fractures are painful and can be assoicated with decreased quality of life, as well as significant morbidity and mortality. Those who experience fractures often have some degree of permanent disability, and in the United States, up to 25% of patients who experience a hip fracture may be transferred to a nursing home.3

    This review examines how women at high risk for osteoporotic fracture can benefit from an osteoporosis therapy with a rapid onset of antifracture efficacy.

    Risk factors/need for protection


    Table 1 Osteoporosis and fragility fracture risk factors in postmenopausal women*
    Postmenopausal women are at risk for developing osteoporosis and related fractures. Risk factors for osteoporotic fractures include low BMD, prevalent fracture, increasing age, low body weight, height loss, certain medical disorders (eg, inflammatory bowel disease, rheumatoid arthritis, hyperthyroidism, celiac disease), and history of fracture in a first-degree relative (see Table 1).3 In addition to menopause, conditions or procedures associated with accelerated bone loss include use of some medications (eg, glucocorticoids, anticonvulsants such as phenytoin and phenobarbital, and cytotoxic drugs), transplantation, and immobilization (due to disease or trauma).3


    Redonda G. Miller, MD, MBA
    Dr. Miller is assistant professor of medicine, department of medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.