Osteoporosis

New Trends in
Prevention and Treatment

.Prof. Bari Kaplan MD

2-4-2003 .
The management of
postmenopausal osteoporosis
first focuses on identifying the
womans risk factors,
then selecting measures that will
reduce modifiable risk factors
through lifestyle changes and, if
If pharmacologic therapy is indicated
FDA-approved options are:
Estrogens (prevention only) according
FDA new statement.
Bisphosphonates and Selective estrogen-
receptor modulators (prevention and
treatment),
Calcitonin (treatment only).
PTH
 Anti fracture efficacy of the most frequently used treatment of
postmenopausal osteoporosis in addition to the effects of
calcium or vitamin D supplementation, or both, as derived
.from placebo controlled randomized trials
DRUG Vertebral # Non Vertebral #
Alendronate +++ ++

Calcitonin + 0

Etidronate + 0

Fluoride -

HRT + 0

PTH +++ ++

Raloxifene +++ 0

Risedronate +++ ++

Vitamin D derivatives 0

Delmas, The Lancet 359:2018-2026, 2002

 Magnitude of the Treatment Effect on
Vertebral and Non Vertebral Fractures
in Postmenopausal Woman with Osteoporosis
1.6
P < 0.05
Relative Risk for Fractures

1.4 #SPINE
P=0.05
1.2 #NONSPINE
1

0.8

0.6

0.4

0.2

0
CA VIT D ALN RIS RLX HRT SCT FLU ETD
n=576 n=1,130 n=9,360 n=2,604 n=6,828 n=3,117 n=1,108 n=646 n=1,076
CRANNEY A et al . ENDOCRINE REV 2002, 23(4);570 - 578
CA=Calcitonon,VIT D=Vitamin D,ALN=Alendronate ,RIS=Risedronate ,RLX=Raloxifen,SCT=Calcitonin,FLU=Fluoride,ETD =Etidronate
 Therapeutic Management of Postmenopausal
Osteoporosis
Short-term Osteoporosis
Osteoporosis Osteoporosis treatment
vasomotor prevention
treatment with or with multiple fractures
symptom T-score 1 to 2.5
without and at risk for hip fracture
management
previous fracture
T-score < -2.5

PT
Raloxifene H

HRT
Bisphosphonate
s

50 55 60 65 70 75 80 85
90
HRT=hormone replacement therapy

Age (years)
Osteoporosis Therapy Algorithm
Postmenopausal Women
Post Vasomotor Symptoms
During Hot Post Fracture
Flashes Pre fracture

PTH
Risk
of Fracture
Raloxifene Bisphosphonates

HRT
HRT Calcitonin

AGE
STAGE At Risk/Osteopenia Osteoporosis Severe Osteoporosis

Higher Lower
BMD (T-score) -2.5