0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18
Osteoporosis 1111■Estrogen/HRT:
➣Conjugated equine estrogens
➣Conserves BMD at menopause
➣Long-term (>5 y) estrogen reduces risk of all fractures
➣Decision to prescribe requires individualized assessment of mul-
tiple health risks
➣Selective estradiol receptor modulator (SERM): raloxifene
■Bisphosphonates: alendronate, risedronate
■Side Effects & Contraindications
■Bisphosphonates:
➣Side effects: esophageal irritation,∼10% of patients; if intolerant
to one, try another bisphosphonate
➣Contraindications: previous severe intolerance, intestinal mal-
absorption due to disease or surgery
■Raloxifene:
➣Side effects: occasional increase in frequency and severity of hot
flashes; rarely, deep venous thrombosis
➣Contraindications: premenopausal, pregnancy, history of
venous thrombosis, pulmonary emboli
■Calcitonin:
➣Side effects: rhinorrhea, nasal irritation
➣Contraindications: none
■Estrogen/HRT:
➣Side effects: vaginal bleeding, venous thrombosis, pulmonary
embolus, breast cancer, endometrial cancer
➣Contraindications: women with recent (<3 y) MI, recent (<5 y)
breast cancer, recurrent DVT or pulmonary embolus
BONE ANABOLIC THERAPY:
■Teriparatide (recombinant human PTH1–34): directly stimulates
new bone formation, increases trabecular and cortical bone
throughout skeleton. 65% reduction in all vertebral fractures, 80%
reduction in moderate/severe vertebral fractures within 18 months.
53% reduction in non-vertebral fractures. Given by single daily injec-
tion of 20 mcg for up to 2 years. Preclinical finding of osteosarcoma
in rats, but no evidence of human equivalent.follow-up
■Assess annually for fractures, functional status, height loss
■Reevaluate BMD not less than 2 y after initiating treatment