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AMBULATORY CARE

Comparing Therapies for Postmenopausal Osteoporosis Prevention and Treatment

Assistant Professor, College of Pharmacy, University of Tennessee; Associate Director, Drug Information Center, University of Tennessee Health Science Center, Memphis, TN

Kimberly B Lloyd, PharmD

Assistant Professor, Harrison School of Pharmacy; Director, Auburn University Pharmaceutical Care Center, Auburn University, Auburn, AL

Erin M Timpe, PharmD

Assistant Professor, College of Pharmacy, University of Tennessee, University of Tennessee Health Science Center

Reprints: Samantha F Eichner PharmD, Drug Information Center, University of Tennessee Health Science Center, 875 Monroe Ave., Suite 117, Memphis, TN 38163-0001, FAX 901/448-5419, E-mail seichner{at}utmem.edu

OBJECTIVE: To review the literature concerning the efficacy of calcium, hormone replacement therapy (HRT), bisphosphonates, selective estrogen receptor modulators, and calcitonin in the prevention and treatment of postmenopausal osteoporosis.

DATA SOURCES: Articles were identified through searches of the MEDLINE (1966–July 2002), EMBASE (1980–July 2002), and International Pharmaceutical Abstracts (1970–July 2002) databases using the key words osteoporosis, postmenopausal, fracture, calcium, vitamin D, hormone replacement therapy, bisphosphonates, alendronate, risedronate, raloxifene, and calcitonin. Additional references were located through review of the bibliographies of the articles cited. Searches were not limited by time restriction, language, or human subject.

STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies of the use of calcium and antiresorptive therapies for the prevention and treatment of postmenopausal osteoporosis were selected. Articles evaluating bone mineral density (BMD) or fracture efficacy were included in this review.

DATA SYNTHESIS: HRT, bisphosphonates, raloxifene, and calcitonin have demonstrated stabilization of and improvement in BMD. Randomized clinical trials have shown fracture risk reduction with bisphosphonates, raloxifene, HRT, calcium, and calcitonin. The largest risk reductions have been reported with use of bisphosphonates in several trials.

CONCLUSIONS: Several therapeutic options with well-documented improvements in BMD and reductions in fracture risk are available to women for the prevention and treatment of postmenopausal osteoporosis.

Key Words: bisphosphonates, calcitonin, calcium, hormone replacement therapy, postmenopausal osteoporosis, raloxifene

Published Online, March 28, 2003. www.theannals.com, DOI 10.1345/aph.1C246

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-03-011-H01

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