Original Article
Osteoporosis in Postmenopausal Women: Considerations in Prevention and Treatment (Women's Health Series)
Abstract
Osteoporosis, the most common human bone disease, affects 8 million American women and has significant morbidity and mortality. Screening is important in older women and younger postmenopausal women with additional risk factors for osteoporosis/fracture. Preventive measures include avoiding smoking, excessive alcohol/caffeine intake, and falls in addition to maintaining adequate calcium/vitamin D intake and exercise. Estrogen/hormone therapy may be considered in some patients. Various medications have proven efficacy in treating postmenopausal osteoporosis; however, potential adverse effects such as hypocalcemia, worsening of renal impairment, and osteonecrosis of the jaw must be considered. The optimal duration of therapy requires further investigation.This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. US Department of Health and Human Services. Bone health and osteoporosis: a report of the Surgeon General. http://www.surgeongeneral.gov/library/reports/bonehealth/content.html. Published 2004. Accessed September 20, 2012.
2. National Osteoporosis Foundation. Fast facts. http://www.nof.org/connect/get-the-facts. Accessed September 20, 2012.
3. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis.http://www.nof.org/files/nof/public/content/file/344/upload/159.pdf. Published 2010. Accessed September 20, 2012.
4. US Preventive Services Task Force. Screening for osteoporosis: recommendation statement. Am Fam Physician. 2011; 83: 1197–1200.
5. Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010; 17: 25–54.
5a. National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. http://nof.org/hcp/clinicians-guidehttp://nof.org/hcp/clinicians-guide. Published 2013. Accessed July 12, 2013
6. International Society for Clinical Densitometry. 2007 ISCD official positions brochure. http://www.iscd.org/wp-content/themes/iscd/pdfs/official-positions/ISCD2007OfficialPositions-Adult.pdf. Published October 2007. Accessed September 20, 2012.
7. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis (WHO technical report series 843). Ann Rheum Dis. 1995; 54: 548
8. Saag KG, Geusens P. Progress in osteoporosis and fracture prevention: focus on postmenopausal women. Arthritis Res Ther. 2009; 11: 251
9. National Osteoporosis Foundation. National Osteoporosis Foundation (NOF) /International Society for Clinical Densitometry (ISCD) recommendations to DXA manufacturers for FRAX implementation. http://www.nof.org/files/nof/public/content/resource/862/files/392.pdf. Published 2010. Accessed September 20, 2012.
10. Krall EA, Dawson-Hughes B. Smoking and bone loss among postmenopausal women. J Bone Miner Res. 1991; 6: 331–338.
11. Krall EA, Dawson-Hughes B. Smoking increases bone loss and decreases intestinal calcium absorption. J Bone Miner Res. 1999; 14: 215–220.
12. Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: a meta-analysis. Osteoporos Int. 2005; 16: 155–162.
13. Baron JA, Farahmand BY, Weiderpass E, et al. Cigarette smoking, alcohol consumption, and risk of hip fracture in women. Arch Intern Med. 2001; 161: 983–988.
14. Felson DT, Zhang Y, Hannan MT, et al. Alcohol intake and bone mineral density in elderly men and women. The Framingham Study. Am J Epidemiol. 1995; 142: 485–492.
15. Tucker KL, Jugdaohsingh R, Powell JJ, et al. Effects of beer, wine, and liquor intakes on bone mineral density in older men and women. Am J Clin Nutr. 2009; 89: 1188–1196.
16. Kool B, Ameratunga S, Robinson E, et al. The contribution of alcohol to falls at home among working-aged adults. Alcohol. 2008; 42: 383–388.
17. Kanis JA, Johansson H, Johnell O, et al. Alcohol intake as a risk factor for fracture. Osteoporos Int. 2005; 16: 737–742.
18. Rapuri PB, Gallagher JC, Kinyamu HK, et al. Caffeine intake increases the rate of bone loss in elderly women and interacts with vitamin D receptor genotypes. Am J Clin Nutr. 2001; 74: 694–700.
19. Hallström H, Wolk A, Glynn A, et al. Coffee, tea, and caffeine consumption in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporos Int. 2006; 17: 1055–1064.
20. Hansen SA, Folsom AR, Kushi LH, et al. Association of fractures with caffeine and alcohol in postmenopausal women: the Iowa Women’s Health Study. Public Health Nutr. 2000; 3: 253–261.
21. Nordin BE. The effect of calcium supplementation on bone loss in 32 controlled trials in postmenopausal women. Osteoporos Int. 2009; 20: 2135–2143.
22. Jackson RD, LaCroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006; 354: 669–683.
23. Dawson-Hughes B. Calcium plus vitamin D and the risk of fractures. N Engl J Med. 2006; 354: 2285–2287.
24. Prince RL, Devine A, Dhaliwal SS, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med. 2006; 166: 869–875.
25. Avenell A, Gillespie WJ, Gillespie LD, et al. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database Syst Rev. 2009; 15: CD000227
26. Bischoff-Ferrari HA, Willett WC, Wong JB, et al. Fracture prevention with vitamin D supplementation–a meta-analysis of randomized controlled trials. JAMA. 2005; 293: 2257–2264.
27. National Research Council. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC, The National Academies Press, 1997; .
28. Hathcock JN, Shao A, Vieth R, et al. Risk assessment for vitamin D. Am J Clin Nutr. 2007; 85: 6–18.
29. Bolland MJ, Grey A, Avenell A, et al. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. 2011; 342: d2040
30. Body JJ, Bergmann P, Boonen S, et al. Extraskeletal benefits and risks of calcium, vitamin D, and anti-osteoporosis medications. Osteoporos Int. 2012; 23: S1–S23.
31. Curhan GC, Willett WC, Rimm EB, et al. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med. 1993; 328: 833–838.
32. Curhan GC, Willett WC, Speizer FE, et al. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med. 1997; 126: 497–504.
33. Curhan CG, Willett WC, Knight EL, et al. Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med. 2004; 164: 885–891.
34. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357: 266–281.
35. Malabanan A, Veronikis IE, Holick MF. Redefining vitamin D insufficiency. Lancet. 1998; 351: 805–806.
36. Holick MF, Siris ES, Binkley N, et al. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab. 2005; 90: 3215–3224.
37. Lips P, Hosking D, Lippuner K, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006; 260: 245–254.
38. Prince RL, Austin N, Devine A, et al. Effects of ergocalciferol added to calcium on the risk of falls in elderly high-risk women. Arch Intern Med. 2008; 168: 103–108.
39. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al. Effect of vitamin D on falls: a meta-analysis. JAMA. 2004; 291: 1999–2006.
40. Janssen HC, Samson MM, Verhaar HJ. Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr. 2002; 75: 611–615.
41. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006; 81: 353–373.
42. Polidoulis I, Beyene J, Cheung AM. The effect of exercise on pQCT parameters of bone structure and strength in postmenopausal women—a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int. 2012; 23: 39–51.
43. Bocalini DS, Serra AJ, dos Santos L, et al. Strength training preserves the bone mineral density of postmenopausal women without hormone replacement therapy. J Aging Health. 2009; 21: 519–527.
44. Bemben DA, Bemben MG. Dose-response effect of 40 weeks of resistance training on bone mineral density in older adults. Osteoporos Int. 2011; 22: 179–186.
45. Zehnacker CH, Bemis-Dougherty A . Effect of weighted exercises on bone mineral density in post menopausal women. A systematic review. J Geriatr Phys Ther. 2007; 30: 79–88.
46. Martyn-St James M, Carroll S. Meta-analysis of walking for preservation of bone mineral density in postmenopausal women. Bone. 2008; 43: 521–531.
47. Tolomio S, Ermolao A, Lalli A, et al. The effect of a multicomponent dual-modality exercise program targeting osteoporosis on bone health status and physical function capacity of postmenopausal women. J Women Aging. 2010; 22: 241–254.
48. Teixeira LE, Silva KN, Imoto AM, et al. Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial. Osteoporos Int. 2010; 21: 589–596.
49. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002; 288: 321–333.
50. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003; 349: 523–534.
51. Stefanick ML, Anderson GL, Margolis KL, et al. Effects of conjugated equine estrogens on breast cancer and mammography screening in postmenopausal women with hysterectomy. JAMA. 2006; 295: 1647–1657.
52. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996; 348: 1535–1541.
53. Harris ST, Watts NB, Genant HK, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999; 282: 1344–1352.
54. Reginster J, Minne HW, Sorensen OH, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000; 11: 83–91.
55. McClung MR, Geusens P, Miller PD, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med. 2001; 344: 333–340.
56. Chestnut CH III, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004; 19: 1241–1249.
57. Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007; 356: 1809–1822.
58. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA. 1999; 282: 637–645.
59. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001; 344: 1434–1441.
60. Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009; 361: 756–765.
61. Chesnut CH 3rd, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med. 2000; 109: 267–276.
62. Reginster J. Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs. 2011; 71: 65–78.
63. PDR Network. Physician’s Desk Reference. http://www.pdr.net. Published 2012. Accessed September 13, 2012.
64. Khosla S, Burr D, Cauley J, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007; 22: 1479–1491.
65. Shannon J, Shannon J, Modelevsky S, et al. Bisphosphonates and osteonecrosis of the jaw. J Am Geriatr Soc. 2011; 59: 2350–2355.
66. Meier RP, Perneger TV, Stern R, et al. Increasing occurrence of atypical femoral fractures associated with bisphosphonate use. Arch Intern Med. 2012; 172: 930–936.
67. Green J, Czanner G, Reeves G, et al. Oral bisphosphonates and risk of cancer of oesophagus, stomach, and colorectum: case-control analysis within a UK primary care cohort. BMJ. 2010; 341: c4444
68. Cardwell CR, Abnet CC, Cantwell MM, et al. Exposure to oral bisphosphonates and risk of esophageal cancer. JAMA. 2010; 304: 657–663.
69. Dore RK. The RANKL pathway and denosumab. Rheum Dis Clin North Am. 2011; 37: 433–452.
70. Traynor K. Experts recommend against calcitonin-salmon for postmenopausal osteoporosis. Am J Health Syst Pharm. 2013; 70: 648–650.
