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Postmenopausal Osteoporosis

 

Key Points

  • The management of postmenopausal osteoporosis involves an individualised regimen of dietary intervention (calcium, vitamin D), lifestyle modification (exercise, avoidance of falls), and, if necessary, pharmacological therapy.

  • Oestrogen is the drug of choice (prevention + treatment), although the potential benefits (skeleton, heart) must be balanced against the possible risks (cancer).

  • Because not every women is willing or able to take oestrogen or HRT, other therapies are needed; calcitonin (treatment), alendronate (prevention + treatment) and raloxifene (prevention) are safe and effective alternatives.

  • Active vitamin D metabolites may be of benefit in some women, although their place in the treatment of postmenopausal osteoporosis remains unclear.

 

ERT/HRT: 'Plusses and minuses'

Positive effects

  • Bone loss
  • Fracture Rate
  • Menopausal symptoms
  • CHD mortality
  • Risk of Alzheimer's disease

Negative effects

  • Vaginal bleeding, nausea, breast tenderness (oestrogen)
  • Risk of uterine cancer (unopposed oestrogen)
  • Risk of breast cancer (unopposed oestrogen)
  • Risk of thromboembolism (oestrogen)
  • Fluid retention, weight gain, premenstrual syndrome (progestogen)


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