Postmenopausal osteoporosis: Fracture consequences and treatment efficacy vary by skeletal site

At least half of all postmenopausal women will experience fractures during their lifetime, and the consequences are often serious, but most women at r isk are not receiving adequate treatment. The objective of this paper is to summarize the literature concerning the consequences of osteoporotic fract ures, and the effectiveness of pharmacologic agents for preventing fracture s and their consequences, emphasizing a systematic, evidence-based summary of treatment results from randomized, controlled trials that were published previously. Osteoporosis is associated with increased risk of fractures at most skeletal sites. Hip fractures have much greater prognostic significan ce in terms of health than any other single type of fracture. However, symp tomatic vertebral fractures and other non-hip fractures also represent enor mous morbidity and economic burdens, and signal increased risk of future fr actures of all types, including the hip. There is convincing evidence that true bisphosphonates (alendronate and risedronate) reduce the risk of both spine and non-spine fractures. The evidence for reducing hip fracture risk is greater for alendronate, with a consistent similar to 50% reduction in h ip fractures across studies. Alendronate has also been demonstrated to main tain quality of life by reducing outcomes such as hospitalization and bed r est related to back pain. Among other agents, raloxifene reduces the risk o f vertebral fractures by approximately 30%; the published evidence for most other agents is inconclusive. Osteoporosis should be regarded as seriously as other important chronic disorders such as hypertension and hyperlipidem ia. Postmenopausal patients with a high risk of fractures - such as those w ith prior fractures or osteoporosis as measured by BMD - need to be treated . Although other therapeutic modalities are available, the evidence is most convincing for the bisphosphonates, alendronate; and risedronate. (C)2000, Editrice Kurtis.