Osteoporosis New Trends in

Prevention and Treatment

DR. RABI NARAYAN SATAPATHY

ASST.PROFESSOR

DEPT. OF OBST.& GYNAECOLOGY

SCB MEDICAL COLLEGE, CUTTACK

MOB-09861281510

EMAIL-drrabisatpathy@gmail.com

The management of postmenopausal osteoporosis first focuses on identifying the woman’s risk factors, then selecting measures that will reduce modifiable risk factors through lifestyle changes and, if indicated, pharmacologic therapy.

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

CRANNEY A et al . ENDOCRINE REV 2002, 23(4);570 - 578CA=Calcitonon,VIT D=Vitamin D,ALN=Alendronate ,RIS=Risedronate ,RLX=Raloxifen,SCT=Calcitonin,FLU=Fluoride,ETD =Etidronate

0.2

0

0.4

0.6

0.8

1

1.2

1.4

1.6

Rel

ativ

e R

isk

fo

r F

ract

ure

s

CAn=576

VIT Dn=1,130

ALNn=9,360

RISn=2,604

RLXn=6,828

HRTn=3,117

SCTn=1,108

FLUn=646

SPINE #

NONSPINE #

P < 0.05

P=0.05

ETDn=1,076

Osteoporosis prevention

T-score –1 to –2.5

Osteoporosis treatment with or

without previous fracture

T-score < -2.5

Osteoporosis treatment with multiple fractures and at risk for hip fracture

50 55 60 65 70 75 80 85

90

Raloxifene

Age (years)

HRT=hormone replacement therapy

HRT

Therapeutic Management of Postmenopausal Osteoporosis

PTH

Short-term vasomotor symptom

management

Bisphosphonates

Raloxifene

PTH

CalcitoninHRTHRT

HRTHRT

During Hot Flashes

Post Vasomotor SymptomsPre fracture

Post Fracture

Risk of Fracture

AGE

At Risk/Osteopenia Osteoporosis Severe OsteoporosisSTAGE

LowerHigher-2.5BMD (T-score)

Bisphosphonates

Osteoporosis Therapy AlgorithmOsteoporosis Therapy AlgorithmPostmenopausal WomenPostmenopausal Women