PATHOPHYSIOLOGY, PREVENTION AND TREATMENT OF AGE-RELATED OSTEOPOROSIS IN WOMEN
3. MANAGEMENT OPTIONS FOR AGE-RELATED OSTEOPOROSIS
3.8 Current recommendations
A summary on current recommendations on prevention and treatment is shown in Table 2. Primary prevention, i.e., measures directed at the general population without individual risk assessment, may include life-style advice (diet, cessation of smoking, and exercise). In countries of high latitudes where the food is not fortified by addition of vitamin-D and the prevalence of vitamin-D insufficiency in the elderly population is high, supplementation with vitamin-D and calcium seem appropriate above the age of 65 years.
In patients with osteoporosis as determined by dual energy absorptiometry (DEXA), secondary prevention with anti-catabolic agents (bisphonates, SERMs) or strontium ranelate should be considered. HRT may be used in women with climac- teric symptoms; however, duration of therapy should be limited. These treatments should be accompanied by calcium and vitamin-D supplementation. Combination of anti-catabolic agents is usually not recommended.
The same options should be considered as tertiary prevention (i.e., in patients with osteoporotic fractures of the spine). In these patients, however, anabolic therapy with PTH(1–34) for 18 months followed by a bisphosphonates may be discussed.
In all cases, the patients symptoms (i.e., prevalent vertebral fractures and fracture history), risk factors for new fractures, and bone mineral density should be balanced against potential side effects. Also, the patient’s preference regarding
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e.g., administration should be considered. Finally, cost-efficacy and national rules on reimbursement should be considered.
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