Prevention of osteoporotic fractures in post-menopausal women

A number of pharmacological interventions are now available for the prevent ion of osteoporotic fractures in post-menopausal women. These include hormo ne replacement therapy, bisphosphonates, raloxifene, calcitonin, calcitriol and combined calcium and vitamin D. Factors influencing the positioning of these agents in clinical practice include their efficacy in preventing fra ctures at both the spine and the hip, tolerability, side-effects, cost and, in the case of raloxifene and hormone replacement therapy, the extra-skele tal risks and benefits of long-term treatment. The rates of onset and offse t of the treatment effect are also important considerations; the observatio ns that relatively short-term intervention produces a significant reduction in fracture risk in women with established osteoporosis, that treatment be nefits are greatest in those with low bone mineral density and that the ben eficial skeletal effects are not maintained after the withdrawal of treatme nt have resulted in a shift from long-term preventive strategies towards th e targeting of high-risk individuals for intervention.