MEDICAL MANAGEMENT OF

OSTEOPOROSIS IN
MENOPAUSAL WOMEN
• Treatment modalities or choices are based on
Age
Health
Risk factors
Each type of modality is associated with benefits and risk
factors
 MEDICAL MANAGEMNET
INCLUDES
• 1. BIPHOISPHONATES
• 2. SELECTIVE ESTROGEN RECEPTOR MODULATORS
• 3. MENOPAUSAL HORMONE THERAPY
• 4. VITAMIN D AND CALCIUM SUPPLIMENTS
• 5. DENOSUMAB
• 6. PARATHYROID HORMONE
 BIPHOSPHONATES
• Anti resorptive agents for the treatment of osteoporosis.
• They bind to mineralized tissues.
• They can rebound to mineralized tissue again.
• They prevent bone thinning.
• ALENDRONATE is the first drug of choice, taken orally once in a week over 70mg.
• Oral administration is poorly absorbed.
• Gastro intestinal upset and osteonecrosis are the side effects.
 SELECTIVE ESTROGEN RECEPTOR
MODULATORS (SERM’S)
• These receptors respond to the hormone estrogen.
• SERMS work by blocking the estrogen effect at some receptors while
promoting an estrogen effect at others.
• RALOXIFENE is the choice of drug taken orally over 60mg /day.
• Potential side effects are hot flushes, sightly increased risk of clots in the
veins( deep vein thrombosis).
 MENOPAUSAL HORMONE
THERAPY(MHT)
• Previously it is known as hormonal replacement therapy.
• It is considered as first line of treatment in women less than 60 years og age .
• It reduces risk of spinal fractures by 40%, bone loss resumes once therapy stopped.
• This therapy can be given in two types.
1. Estrogen therapy
2. Estrogen and Progesterone therapy.
ESTROGEN THERAPY
• It is taken as pill, patch, vaginal ring, cream, gel and spray in low doses only.

ESTROGEN AND PROGESTERON THERAPY

It is also called combination therapy.
It relieves menopausal symptoms such as sleep disturbances, vaginal dryness, hot flushes,
night sweats.
It prevents bone loss.

MHT associated health problems are hip and spine fractures, vaginal bleeding, dementia,
breast cancers.
 VITAMIN D AND CALCIUM
SUPPLIMENTS
• Vitamin d enables the body to absorb calcium and calcium is necessary
for maintaining bone density.
• Around the time of menopause , women may be prescribed vitamin d
and calcium supplements.
• The current recommendation is to maximize the dietary consumption of
calcium rich food to achieve the dietary target intake of 1300mg/day.
• The excessive calcium intake leads to increased risk of heart diseases.
 DENOSUMAB
• It is a human monoclonal antibody for the treatment of osteoporosis.
• They are prdia, xgeva. These are the choice of drugs.
• It is used to treat bone loss.
• It is mainly prescribed to women aged 70 years or elder.
• It improves bone mineral density (BMD) and to reduce the incidence of vertebral and non
vertebral fractures in meno pausal women.
• It is contra indicated in people who are having low calcium levels in blood.
• Side effects of denosumab are skin infections, rashes, low calcium levels and joint pains.
 PARA THYROID HORMONE
• It is administered as daily basis in sub cutaneous manner.
• Calcium and vitamin d supplements are necessary for para thyroid treatment.
• Dosage is 20mcq daily , subcutaneous over two years of time period.