Risk of fracture and treatment to prevent osteoporosis-related fracture in postmenopausal women. A review.

Objective: To review the antifracture efficacy of pharmacologic therapy approved by the U.S. Food and Drug Administration for the treatment of postmenopausal osteoporosis.

Methods: For this literature review, published trials of antiresorptive therapy with the bisphosphonates risedronate and alendronate, the selective estrogen receptor modulator raloxifene and calcitonin were reviewed; hormone replacement therapy was not included as this modality is not indicated for treatment of osteoporosis.

Results: In controlled trials of postmenopausal women with osteoporosis, risedronate reduced the incidence of clinically evident vertebral fracture after 6 months of therapy and radiographically detected vertebral and nonvertebral fracture after 1 year. In similar trials, alendronate also reduced the risk of clinical vertebral fractures in 1 year. Risedronate and alendronate were both well tolerated, but some trials of alendronate were closed to women with recent upper gastrointestinal disease. In a large, controlled trial, raloxifene demonstrated a significant reduction in the risk of clinical vertebral fracture but not in the risk of nonvertebral fracture. Raloxifene is also associated with a 3-fold increased risk of thromboembolism. Calcitonin reduced the incidence of vertebral fracture, but there are no conclusive data on prevention of nonvertebral fracture.

Conclusions: Antiresorptive therapy can reduce the risk of osteoporotic vertebral fracture. The bisphosphonates are also effective in reducing the risk of hip fracture in women with osteoporosis.