ADVANCES IN DIAGNOSIS AND MANAGEMENT OF POSTMENOPAUSAL OSTEOPOROSIS

Abstract

Postmenopausal osteoporosis is the most prevalent bone problem in elderly females, the increase of its incidence is due to the increasing number of women living beyond their reproductive age. It has been stated that bone resorption in women at about the age of 50 years is due to declining ovarian function, although it may start before the onset of menopause with significant increase in serum follicle stimulating hormone (FSH) concentration and concomitant decrease in estradiol () level, the key endocrinologic event of menopause is the decrease in the ovarian production of estrogen followed by secondary increase in gonadotrophs secretion and some relative minor alteration in androgen activity. Management of each patient differ from the other as we need full assessment of the general condition and detection of indication to treatment, it is obtained by: a- Proper examination to detect hypertension, cardiac disease and liver diseases. b- BMD measurement. c- Serum lipids and lipoprotein profile, serum calcium. d- Social and family history.

If the risk factors are minimal as: the BMD is normal or not decreasing on follow-up, no cardiovascular risk, the effect of estrogen is less important and the patient can benefit from proper diet, exercise and calcium, vitamin D supplementation especially if menopausal symptoms are not present as hot flushes and urogenital symptoms.

New studies pay attention to other alternatives for patients whom HRT is undesirable or contraindicated, they give similar effects to estrogen in some aspects and lack some benefits, they include: • SERMs, a novel class of selective estrogen receptor modulators, have potential as viable alternative to estrogen in HRT. Raloxifene, a non steroid benzothiophene has beneficial agonist effects on bone and cardiovascular risk and estrogenic antagonist effects on breast and uterus, with decrease in total and low density lipoprotein cholesterol levels similar to that seen with HRT. It also reduces plasma concentration of homocysteine an independent risk factor for atherosclerosis and thromboembolic disease. • Alendronates is a potent aminobisphosphonate, it's effective in preventing bone loss and reduce the fracture risk more than 50 %, but have no effect on cardiovascular risk, hot flushes or atrophic menopausal changes. • Tibolone is a steroid, related to 19-nortestosterone family, effective in treatment of osteoporosis and hot flushes, it has estrogenic effect on the vagina induces atrophy of the endometrium but it is expensive.