Is It Safe to Prevent and Treat Postmenopausal Osteoporosis?

Abstract

Osteoporosis is a major health problem, and various treatment options are available to prevent fractures. The efficacy of most therapies is similar, but costs vary enormously and adverse effects are seen with all treatments. HRT is the optimal treatment for prevention of postmenopausal osteoporosis in terms of efficacy, safety, and cost. The risks of this treatment have been overstated and are far outweighed by the benefits. This should be considered as first-line therapy for prevention. Bisphosphonates are an effective alternative treatment for established osteoporosis. They are associated with a number of adverse effects including atrial fibrillation, osteonecrosis of the jaw, and fragility fractures of the femoral shaft. Whether other adverse effects will emerge in the long term remains to be seen, but their long skeletal retention time should caution against their use in younger patients. Denosumab is a new therapy that has a convenient dosing schedule and is not retained in the skeleton. It has a powerful anti-resorptive effect and thus carries the same risks for osteonecrosis of the jaw and fragility fractures of the femoral shaft as the bisphosphonates. Other alternative treatments are less effective or have either been withdrawn (calcitonin) or limited in their use (strontium ranelate) because of adverse effects.