POSTMENOPAUSAL OSTEOPOROSIS - PATIENT CHOICES AND OUTCOMES

Objective: Only two medications, estrogen and injectable salmon calcit onin, are currently approved by the FDA for the treatment of osteoporo sis, Oral etidronate has been investigated but not approved for osteop orosis therapy. We compared the three available anti-resorptive medica tions in untreated osteoporotic women. Design: A non-randomized, open label trial. After baseline biochemistry and bone mineral density (BMD ) determinations, subjects self-selected therapy based on descriptions of the three drugs which were similar for all patients. Bone densitom etry of the lumbar spine, femoral neck and distal and proximal forearm sites was repeated every 6 months. Results: Twenty-one patients chose estrogen, 20 chose etidronate and 11 chose calcitonin. Fear of breast cancer was the most common reason given for not choosing estrogen the rapy, Mean age was slightly lower and spine and hip bone densities sli ghtly higher in the estrogen group compared with both the etidronate a nd calcitonin groups, In the lumbar spine, all three agents resulted i n similar small increments (mean increments 1.2-4.4% at 2 years), In t he estrogen group, there was no change in femoral neck density while t here were significant losses in both calcitonin and etidronate groups (3.1-4.9%), In the forearm, there was either no change (distal site) o r an increment (proximal site) in the estrogen group, while both etidr onate and calcitonin groups demonstrated a mean loss at both sites ove r the 2-year observation period, Conclusions: These preliminary result s suggest that all three agents appear equally effective at maintainin g or increasing BMD of the lumbar spine, while estrogen appeared more effective at maintaining or increasing BMD of the appendicular skeleto n, This study underscores the need for an alternative to estrogen ther apy which is equally effective and can be given orally for those in wh om estrogen is either contraindicated or undesirable.