Management

NON-PHARMACOLOGIC THERAPY:
1. Diet: high in calcium and adequate vitamin D
2. Exercise: Exercise has beneficial effects on bone
mineral density (BMD) in premenopausal and
postmenopausal women. Any weight-bearing
exercise regimen, including walking, is
acceptable.
3. Gait training programs to decrease risk of falling
4. Avoidance of smoking.
PHARMACOLOGIC THERAPY:
1. Bisphosphantes: pyrophosphate analogues that absorb
on to bone surfaces and exert a inhibitory effect on
osteoclasts and decrease bone turnover. (1 st line)
2. Selective oestrogen receptor modulator (raloxifene)
decreases bone resorption by osteoclasts. (2nd line)
3. HRT but the risks and benefits should be discussed with
each individual woman before starting treatment.
(Breast cancer) (2nd line)
4. Vitamin D (800 IU) and Calcium (1-1.2g) supplements
per day.
5. Biological therapy: Denosumab - fully humanised
monoclonal antibody, blocks a specific receptor,
reducing the formation, function and survival of
osteoclasts.