Efficacy and acceptability of risedronate 5 mg daily compared with 35 mg once weekly for the treatment of postmenopausal osteoporosis.

OBJECTIVE: Risedronate is a bisphosphonate used in the treatment of osteoporosis. It has a strong effect in inhibiting osteoclast activity. The primary objective of this study was to evaluate the effectiveness and adverse events of two different forms of risedronate (5 mg and 35 mg) using a rapid biochemical marker for comparison of C-terminal telopeptide (CTx) type I collagen cross-links. METHODS: The study was designed at Bakirkoy Dr. Sadi Konuk Education & Research Hospital, between January and June 2004. A total of 123 postmenopausal osteoporotic women were randomly assigned in blocks of three to one of the following groups: control, risedronate 5 mg/day and risedronate 35 mg once a week. RESULTS: Of the 123 women enrolled, 103 (83.7%) completed the study. Adverse events were experienced by 53.6% in the control group, 56% in the risedronate 5 mg/day group and 53.6% in the group receiving risedronate 35 mg once per week. The most common adverse events were gastrointestinal (21.9% of subjects in group 1, 29.2% of subjects in group 2, 24.3% of subjects in group 3). The women in groups receiving risedronate either 5 mg/day and 35 mg once per week had similarly decreased levels of CTx but the control group was not as effective. CONCLUSION: The results support the hypothesis that risedronate 35 mg given once per week has the same therapeutic efficacy and safety as a daily 5 mg regimen. Taking the medicine once a week is likely to be easier and more satisfactory than the daily regimen. However, patients taking a once-a-week regimen may forget to take it due to the 7-day break without medicine.     

Comparative evaluation of isosorbide mononitrate and alendronate in management of postmenopausal osteoporosis

Background  

Osteoporosis, a skeletal disorder that adversely affects bone strength , is common among postmenopausal women primarily due to reduced ovarian estrogens.     

绝经后骨质疏松防治研究中需要商讨的问题

鉴于绝经后骨质疏松症可以预防,但尚无有效治疗的现状,各国都在继续研究最有效、安全、方便,以及经济的防治方法。我国自８０年代后半期开始,在骨质疏松症的诊断及防治中取得了重大进展,然而在诊断标准及研究方法上存在分岐。为了便于归纳、总结我国各单位在不同地区...     

Estrogens in the prevention of osteoporosis in postmenopausal women

Menopause-related bone loss leaves a woman at high risk for fractures. Estrogen use by postmenopausal women, especially when started within 3 years of the last menstrual period, prevents bone loss and reduces the risk of osteoporotic fractures. Estrogens do not restore lost bone. Withdrawal of estrogen therapy is followed by significant bone loss, thus suggesting that long-term therapy is needed. Concomitant progesterone therapy does not impair estrogen's bone-preserving activity.     

绝经后骨质疏松症的诊断与防治

绝经后骨质疏松症是最常见的一种原发性骨质疏松,其特征是发生在绝经后（多在绝经后5～10年内发病）,主要由绝经引起,而不是由疾病或长期应用药物所引起。其后果则与其他类型的骨质疏松症相似,即易发生骨折,以及由骨折引起的疼痛、骨骼变形及骨折合并症,从而增加老年妇女的伤残率及死亡率。随着世界人口老龄化的趋势,各国对骨质疏松症的研究都十分重视,并在基础研究及临床等方面取得了很大进展。近年来,在绝经后骨质疏松症的诊断及防治方面,不断取得共识,对指导临床工作起到了重要作用。     

Current approach to fracture prevention in postmenopausal osteoporosis

The prevention and management of osteoporosis are becoming increasingly prominent concerns as the number of postmenopausal women reaching old age continues to grow. Often the first sign of osteoporosis is a fractured bone. It is important that women with low bone density be identified as early as possible and measures taken to reverse the process. These include proper diet and exercise, supplements of calcium and vitamin D, and in cases with proven osteoporosis, antiresorptive or anabolic agents to improve bone strength. Women should also be cautioned to avoid falling as much as possible.     

Effect of daily hormone therapy and alendronate use on bone mineral density in postmenopausal women

OBJECTIVE: To evaluate the effect of daily oral and transdermal hormone therapy alone or in combination with alendronate on bone mineral density in postmenopausal women. DESIGN: Comparative prospective clinical study. SETTING: Outpatient clinic of a training and research hospital. PATIENT(S): One hundred seventy-three consecutive postmenopausal women with no previous hormone therapy and a bone mineral density T score <-1 SD were randomly enrolled. INTERVENTION(S): Oral conjugated estrogen, alone or with alendronate, or transdermal estrogen, alone or with alendronate, given for 1 year. All patients also received medroxyprogesterone acetate and calcium. MAIN OUTCOME MEASURE(S): Bone density measurement at L2 to 4 region by dual-energy X-ray absorptiometry. RESULTS: At the end of 1 year, significant increase in bone density measurements were seen in all groups. Oral conjugated estrogen and transdermal estrogen have the same effect on bone mineral density loss. Hormone therapy alone stabilized the bone mineral density loss. Hormone therapy together with alendronate resulted in better values in all groups. CONCLUSION: Hormone therapy is adequate in osteopenic women. However, hormone therapy plus alendronate is advantageous in women with considerable bone mineral density loss.     

Phytoestrogen-containing food and prevention of postmenopausal osteoporosis and cardiovascular diseases

Food phytestrogens and prevention of postmenopausal osteoporotic and cardiovascular disease. Phytestrogens are diphenolic compounds, widely found in plants and foods, with structural and biological estrogen-like similarities. Their anti-estrogenic effects are well known and studied due to the possibility to prevent some tumors such as breast and prostate cancer. In menopause they have an estrogenic-like action on lipidic and bone metabolism. Phytestrogens rich foods can positively affect the postmenopausal osteoporotic and cardiovascular pathology.     

Fracture prevention in postmenopausal osteoporosis: a review of treatment options

Several treatment options are available to reduce the risk of fractures in postmenopausal women with or at risk for osteoporosis. A MEDLINE search was conducted to evaluate anti-fracture and adverse event data of osteoporosis therapies from trials in postmenopausal women. Among the anti-resorptive therapies, the bisphosphonates alendronate and risedronate have demonstrated consistent efficacy in reducing vertebral and nonvertebral fracture risk. Once-weekly alendronate and risedronate produced similar improvements in bone mineral density compared with their once-daily counterparts with similar tolerability. Daily injections of teriparatide resulted in statistically significant reductions in the risk of vertebral and nonvertebral fractures, and trials of ibandronate, raloxifene, and calcitonin nasal spray showed reductions in vertebral fracture risk. Hormone therapy has demonstrated clinical fracture risk reduction; however, safety outcomes from the Women's Health Initiative study have raised concerns regarding long-term use of these preparations. These data can guide clinical decision-making regarding the selection of an osteoporosis therapy. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to summarize adverse events data of osteoporosis therapies from trials in postmenopausal women, explain that only a few therapies have shown a consistent efficacy in reducing vertebral and nonvertebral fractures, and state that data from the Women's Health Initiative study have raised concerns regarding long-term use of estrogen-progestin therapy.     

Therapeutic options: an evidence-based approach to prevention and treatment of osteoporosis

Since the early interruption of the HRT arm of the Women's Health Initiative, many women and their physicians have elected to discontinue their treatment with estrogen and progesterone. These patients are at high risk for rapid bone loss and should have their bone mineral density evaluated soon after the discontinuation of estrogen. Patients found to have low bone density should be offered treatment to prevent fractures. When choosing a therapy, we should use an evidence-based approach, relying on the results of randomized, double-blind, placebo-controlled trials.     

Prevention and treatment of postmenopausal osteoporosis

Osteoporosis is a common skeletal disease characterized by reduced bone strength and increased risk for fractures. Fragility fractures are associated with serious clinical consequences, including chronic pain, skeletal deformities, loss of independence, and increased mortality. Although osteoporosis is underdiagnosed and undertreated, many who are treated take medication incorrectly or do not continue it long enough to benefit. Measures to prevent osteoporosis include a healthy lifestyle, with regular physical activity, adequate intake of calcium and vitamin D, and avoidance of cigarette smoking and excess alcohol. Patients at risk for osteoporosis can be diagnosed with a simple bone density test before the first fracture occurs. Pharmacologic agents for patients at high risk for fracture can reduce the burden of osteoporotic fractures.     

Safety and efficacy of drospirenone used in a continuous combination with 17beta-estradiol for prevention of postmenopausal osteoporosis.

OBJECTIVE: To evaluate the combination of 17beta-estradiol and continuous drospirenone for the prevention of postmenopausal osteoporosis. METHODS: A total of 180 (75%) healthy postmenopausal women aged 45-65 years completed a 2-year prospective study. Bone mineral density (BMD) at lumbar spine, hip and total body as well as endometrial thickness, markers of bone turnover and serum lipids were measured regularly. Treatment groups were given placebo or 1 mg 17beta-estradiol combined with 1, 2 or 3 mg drospirenone daily. RESULTS: BMD at the lumbar spine, hip and total body increased by 7, 4 and 3%, respectively, in all hormone groups versus placebo (all p < 0.001). Bone markers all decreased accordingly (serum osteocalcin 52%, serum bone specific alkaline phosphatase 36%, serum CrossLaps 67% and urinary CrossLaps 75% from baseline; all p < 0.001). Total cholesterol and low-density lipoprotein cholesterol decreased by 8% and 13%, respectively (both p < 0.001). High-density lipoprotein cholesterol and triglycerides remained unchanged. No significant dose-related effects were found. Endometrial thickness increased by 1.2 mm only in the 1-mg drospirenone group (p < 0.01 versus placebo). CONCLUSION: The combination of 17beta-estradiol and drospirenone has a positive effect on BMD and a potentially beneficial effect on lipids. Although endometrial thickness increased slightly, the safety of the endometrium was assured, as no cases of hyperplasia or cancer occurred.