Hormonal Replacement Therapy (HRT)

The primary preventative treatment modality in the U.S. for postmenopausal osteoporosis is hormone replacement therapy (HRT). HRT prevents a decrease in bone mass and reduces fracture risk among postmenopausal women. HRT benefits continue for as long as therapy is taken, irrespective of duration of treatment and withdrawal results in decreased bone mass comparable to that following oophorectomy.

It is believed that HRT could potentially prevent 80% of vertebral fractures and reduce hip fractures by about 50%. HRT is also appropriate first-line therapy for patients presenting with fractures from osteoporosis.

Calcitonin

Salmon calcitonin is another medication available for the treatment of osteoporosis. Calcitonin is a peptide hormone secreted by the parafollicular cells of the thyroid that acutely inhibits osteoclast function and diminishes their number over a prolonged period, thus inhibiting bone resorption. Current modes of administration include subcutaneous injection or nasal spray.

Bisphosphonates

Bisphosphonates are a class of drugs found to inhibit osteoclast mediated bone resorption. The precise mode of action of bisphosphonates is not known, but possible mechanisms include interfering with mature osteoclasts, affecting the activation of osteoclasts, and altering the properties of the bone matrix.

Efficacy of bisphosphonates has been established in the treatment of conditions characterized by excessive osteoclastic activity, such as Paget's disease of bone and hypercalcemia associated with malignancy.

Calcium

Treatment of postmenopausal women with calcium therapy has been evaluated. One study looking at the effects of different doses of calcium, found that rates of bone loss were the same, regardless of the calcium regimen. Other studies have show that calcium therapy is not an effective substitute for HRT because calcium alone cannot prevent bone loss.

Vitamin D

Secondary to decreased estrogen production, mild abnormalities of increased parathyroid secretion of parathyroid hormone (PTH) and decreased vitamin D synthesis has been found to contribute to the decrease in bone mass in some women as they enter menopause. Administration of vitamin D suppresses the increased secretion of parathyroid hormone (PTH), and increases intestinal calcium absorption, resulting in a reduction of bone loss.

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