Osteoporosis is age related, with higher incidence in postmenopausal women. Roughly estimated that 200 million people worldwide are affected by osteoporosis.
Osteoporotic fractures are associated with significant morbidity and mortality, and impaired quality of life.
Fractures between those who have more influence on the quality of life are the total hip fracture and multiple fractures of the vertebrae, the latter associated with reduced respiratory function and limitation of movement.

Although there are several drugs on the market for the prevention and / or treatment of postmenopausal osteoporosis, they may not always be appropriate for all women, mainly because of their side effects.

The basic therapy for the prevention and treatment of osteoporosis is represented after taking supplements of calcium and Vitamin-D. Some evidence suggests that supplements with vitamin D and calcium may have a positive effect on bone mineral density, reducing the risk of fractures.

Recent randomized clinical trials, however, have however not shown any effect of taking calcium supplements and vitamin D on reducing the risk of bone fractures.
Calcium taken in the first 5 years of the menopausal period shows a limited effect in reducing the risk of fracture.
A meta-analysis showed that the effect on reducing the risk of bone fractures is achieved by administering a dose of more than 1200 mg of calcium daily.

The oral bisphosphonates are generally considered first-choice therapy for patients with osteoporosis.
Several studies conducted in postmenopausal women with osteoporosis showed that these drugs lead to an improvement in bone density and consequently the reduction of bone fractures, including those of the vertebrae, with a figure of 20% – 50% compared to placebo.
The use of bisphosphonates, however, is limited by gastrointestinal side effects against which occur with: dyspepsia, abdominal pain, gastritis and oesophagitis. The low bioavailability of oral bisphosphonates and the possible gastrointestinal side effects that limit the use of high doses, have helped lead the administration of these drugs intravenously in the treatment of postmenopausal osteoporosis. The intravenous bisphosphonates have the disadvantage of being more expensive than the oral formulations of cause and sometimes flu-like symptoms and myalgia.

Other treatment of postmenopausal osteoporosis include hormone therapy, raloxifene, salmon calcitonin, teriparatide and strontium ranelate.

Hormone therapy, which involves the administration of estrogen alone or in combination with progestin, is approved for the prevention of postmenopausal osteoporosis, although it is most suitable for the treatment of menopausal symptoms, such as, changes and vasomotor ‘ vaginal atrophy.
Hormone therapy has however shown efficacy in reducing the risk of fractures and spinal joint hip joint with a rate of 30-40%, compared to placebo.
Results from two clinical trials suggest that long-term hormone therapy may be associated with an increased risk of myocardial infarction and thromboembolic events, whereas in a study of patients on combination therapy of estrogen / progestin has been observed a small but significant increased risk of breast cancer.
In particular, the Raloxifene (Evista), a selective estrogen receptor modulator (SERM) reduces by 30-50% the risk of vertebral fractures compared with placebo. Clinical studies have also shown that raloxifene reduces the risk of breast cancer by 50-80% compared to placebo, similar percentage to that obtained with tamoxifen (Nolvadex).
Raloxifene showed also a significantly increased risk of thromboembolic events, in particular, the results of a study showed an increased incidence of 49% of events infarctions compared with placebo, raloxifene also produced an increased incidence of vasomotor symptoms such as hot flushes and leg cramps.
The use of raloxifene is not recommended for patients with a history of thromboembolic events and risk of myocardial infarction.
Considering the fact that there are many clinical data in support of reducing the risk of bone fracture and considering the important side effects related to the circulatory system, the Raloxifene is generally regarded as second-choice therapy for the treatment of postmenopausal women with osteoporosis.

Salmon calcitonin (Calcitonin Sandoz) was approved for the treatment of postmenopausal osteoporosis, to be administered intranasally. At a dose of 200 IU / day of salmon calcitonin reduces the risk of vertebral fractures by 33% compared to placebo. However was not observed a significant reduction in risk of fracture and increased bone mineral density also increased the dose of salmon calcitonin.
The intranasal administration of salmon calcitonin leads to an increased incidence of cases of rhinitis.
Therefore, the use of salmon calcitonin is reserved for patients with low compliance with other medications for the treatment of postmenopausal osteoporosis.

The use of teriparatide (Forsteo), active fragment of parathyroid hormone, administered daily by subcutaneous injection, stimulates the formation and bone resorption, increasing bone mineral density, thereby reducing the risk of vertebral fractures and fractures of 65-69% non-vertebral 35-40% compared to placebo.
In a comparative study with alendronate (Fosamax), the Teriparatide causes a greater increase in BMD of the spine and a lower incidence of non-vertebral fractures.
Teriparatite use of associated adverse events such as nausea, dizziness and leg cramps.

In phase II trials in women with postmenopausal osteoporosis strontium ranelate (Osseor / Protelos) at a dose of 2 g / day showed a significant increase in BMD of the spine 12 and 24 months of treatment compared to placebo .
During the second year of treatment with strontium ranelate, the proportion of patients who have suffered a vertebral fracture was reduced by 44% compared to placebo.
In the first three months of treatment can be observed between the adverse events more frequent nausea and diarrhea tend to regress over time.

By analyzing the different therapies, factors that may contribute to poor compliance, and no maintenance therapy for osteoporosis, include drug intolerance, the complexity of the regimen, and lack of understanding of the benefits and risks associated with treatment .

Emerging therapies for postmenopausal osteoporosis are represented by the new SERM (Bazedoxifene, lasofoxifene, Ospemifene, Arzoxifene) and denosumab.

The denosumab (formerly known as AMG 162) is a human monoclonal antibody, active against RANKL (Receptor Activator of Nuclear Factor Kappa B Ligand), involved in the genesis and survival of osteoclasts.
The denosumab indicated for osteoporosis, but also for other diseases of the skeleton, such as bone metastases and multiple myeloma. It is administered by subcutaneous injection every 3 or 6 months.
In a phase II study conducted in postmenopausal women with osteopenia and osteoporosis, treatment with denosumab resulted in a significant increase in BMD of the spine joint hip joint compared with placebo. These changes are similar to or greater than the results obtained with weekly dosing of alendronate.
A phase III trial confirmed these results. Hence, the data obtained from Phase II and III to indicate that the denosumab reduces the risk of fractures in the spine and articulation coxofemorale.

The Bazedoxifene (Conbriza) was approved for the prevention and treatment of osteoporosis in postmenopausal women.
In preclinical studies Bazedoxifene has been shown to reduce the risk of bone fractures caused by osteoporosis and cholesterol levels without evidence of endometrial hyperplasia and breast cancer.

The lasofoxifene (Fablyn) was approved for the prevention and treatment of postmenopausal osteoporosis and vaginal nell’atrofia.
In preclinical studies in experimental animals, the lasofoxifene has reduced the loss by maintaining the consistency of bone tissue, lowering total cholesterol levels.
In a mouse model was also demonstrated that treatment with lasofoxifene produces a low potential for proliferation of uterine and vaginal tissue.

L ‘Ospemifene (Ophena) is a drug candidate for the treatment of atrophy vaginal and prevention of osteoporosis that affects postmenopausal women. In phase II studies conducted in healthy postmenopausal women treated with different doses of Ospemifene, administered daily, we have seen a reduction of bone turnover, the Ospemifene has an effect on biochemical markers of remodeling and bone formation similar to that of raloxifene. (Xagena2009)

Source: Journal of Women’s Health, 2009

Can find more: postmenopausal osteoporosis, therapy postmenopausal osteoporosis, treatment postmenopausal osteoporosis

Osteoporosis postmenopausal women is now in relation to the increased life expectancy, an issue of great interest and importance from the standpoint of clinical and therapeutic. It ‘s the main condition determining the possibility of bone fracture in the absence of major traumatic events. The incidence of fractures in women begins to increase from 40 years onwards, although the data show a sharp increase in women after age 65.

Numerous factors interact negatively with bone mass: a sedentary lifestyle (increased bone resorption with decreased formation of), smoking, excessive intake of alcohol and caffeine.

The nutritional factor certainly plays a major role. Numerous studies have shown that administration of a calcium supplement in the diet (Ann J Med 98:331,1995) is able to slow the rate of bone loss and significantly reduce the risk of fractures in post menopausal.

It has long discussed the amount of calcium needed daily for postmenopausal women, the recommended proportion is around 1500 mg for women after menopause and 1000 mg for those in premenopausal. Hardly, however, Western diets are able to provide such an income which is then integrated pharmaceutical preparations in combination with vitamin D which promotes the intestinal absorption (Ann NY Acad Sci 1998 Nov.20, 854:336-51).

Various diets have been repeatedly studied in view of the fact that some foods such as soybeans contain substances with an estrogen-like action (Maturitas 1995 APR 21 (3) :189-95) and are therefore able to influence positive clinical postmenopausal reducing the number of so-called “hot” heat.

What had become apparent is the absolute necessity of integrating the different diets with calcium and vitamin D (J Endocrinol Invest 1999 Dec; 22 (11) :852-6) to reduce or at least delay the devastating effects on the clinical level but also, in economic terms for society, resulting from bone fractures resulting from the decrease of bone mass and strength. This account nutrition, seemingly trivial, is in fact very often overlooked in daily clinical practice. Indeed we must not forget that if the hormone therapy, which today is much discussed, plays an important role in clinical general welfare of women in post menopausal bone and wellness in particular, has however not contraindications negligible represented by the impossibility of its use in patients who have had breast cancer or thromboembolic complications of prior estrogen therapy, or with a family history of breast or endometrial cancer. To all this must be added the lack of compliance submitted by the patient herself.

For these reasons, it is evident that the lifestyle of a Party and other nutritional factors, represented by a diet low in animal fat and rich in foods containing calcium, such as (per 100 g of edible part) skimmed milk (115 mg), soybean meal (210 mg), rabbit meat (22 mg), turkey (20 mg), anchovies (148 mg), vegetables like arugula (309 mg), sage (600 mg), mint (210 mg), basil (250 mg) in combination with a proper intake of vitamin D, represent the core of anti-osteoporotic post-menopausal therapy in a controlled calorie intake overall is not a disjoint moderate physical activity.

You find more: postmenopausal osteoporosis

Osteoporosis is defined as a disease characterized by reduced bone calcium content and deterioration of the microarchitecture such as to an increased fragility and a tendency to fracture easily. The postmenopausal osteoporosis is that form of osteoporosis that occurs typically after menopause, affecting mainly the part trabecular bone (the inner). causing fractures and vertebral collapse.

E ‘was also called “silent disease” because for much of his course manifesting symptoms unfortunately not only dramatically during its complications are the collapses and vertebral fractures resulting from trauma also very small

Women with this disease manifest with the decrease in stature over the years and with morphologic changes in curvature of the spine.
The lack of estrogen plays an important role in its determinism, but while some years ago was aimed as much about their use can prevent you from today pharmacology great importance to combating the risk factors, life style, a specific treatment for ‘ bone.

The prevention of postmenopausal osteoporosis begins very early, at a young age: the peak bone mass, the maximum increase in bone mineral, it is reached around 25-30 years. And ‘then before the 30 years that a sedentary lifestyle habits such as nutrition or errors will make the difference in future years.
Exercise is also an important moment in the secondary prevention ie when calcium loss has already begun: in fact, the bone is a dynamic structure that affected much of the stress and the tropism of the muscles that surround it.
However, prevention and treatment also pass through a healthy diet with proper calcium and exposure to the sun, essential for skin synthesis of vitamin D. Even good hydration is important

But if symptoms such as osteoporosis can not understand in time if they are infected, or if we still lost a significant amount of our “heritage” soda? The bone density of the Service Area Territorial 8 Civitanova Marche (MC) has a modern ultrasound bone densitometer that through the study of the phalanges of the hand allows in less than ten minutes and without any risk of having a biological response and precise computerized very reliable.

The Bone Densitometry Ultrasound not only provides information on bone calcium content, but unlike other methods allows us to have a sufficiently reliable even representation of what many call the “quality” of bone: in fact the ultrasound beam through the different layers (cortex and medulla) issue of the reflected waves that provide an indirect representation of its architecture.

Many doctors are now sending their patients to Civitanova Marche for this examination, which also allows you to monitor over time the disease and the effect of any treatment, all with very very low cost. The examination is done with fingers, strongly representative of the structures typically affected by osteoporosis postmenopausal. Access is via the provision Unified Reservations Center.

The fight then goes postmenopausal osteoporosis mainly in its prevention and early diagnosis, made it even easier identification of those at risk. The medical and surgical those made in recent years important progress: we now have drugs available that can reverse the natural history of disease, increasing calcification and bone strength and so have developed surgical techniques feasible in day surgery or outpatient able to relieve the pain and complications of reconstruction with the use of special “cement” the crushed vertebrae.

key:Postmenopausal osteoporosis, Postmenopausal osteoporosis guidelines

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density and a deterioration of the microarchitecture of bone tissue.
The bones become fragile and are therefore more exposed to greater risk of minimal trauma fracture.
Fractures are the most important clinical event in osteoporosis, because most often affecting the wrist, vertebrae and femur.
In the case of hip fracture hospitalization is necessary and in most cases require surgery with insertion of protesi.I epidemiological data show that only 50% of patients remain self-sufficient after a fracture of the femur and the quality of later life is still compromised.
The consequences of vertebral fractures are less dramatic but, especially if two or more fractured vertebrae, they can provide continuous back pain, decreased mobility, kyphosis (forward curvature of the spine), loss of height, difficulty breathing.
The importance of osteoporosis derives from its dissemination: the increase in life expectancy that has characterized the last decades has increased the number of individuals at risk of osteoporosis and hence fracture, and the trend is inexorably rising.
According to data from the World Health Organization (WHO), in 1990 there were approximately 1.7 million hip fractures worldwide, 6.3 million are planned for 2050. These issues require increasing attention from health organizations to identify those at risk and the most appropriate therapy, but it also requires a careful individual participation especially with regard to prevention activities.

Q:Can this regimen, as well as stopping the Aciphex, reverse osteoporosis?

A:  Supplemental calcium and vitamin D and weight-bearing exercise are routinely recommended to maintain bone health, especially for postmenopausal women or those who do not get enough of these nutrients in the diet. What’s enough? For most adults, 1,200 milligrams/day of calcium and 800 international units of vitamin D are recommended. Green, leafy vegetables are a good dietary source of calcium, but dairy products (such as milk and yogurt) are even better. Vitamin D can be found in fish (especially salmon and tuna), eggs and fortified milk.

Increasing your intake of calcium and vitamin D and increasing weight-bearing exercise may slow bone loss, especially if intake of calcium and vitamin D are low. However, the evidence is mixed on the ability of calcium, vitamin D and exercising more to actually reverse osteoporosis (that is, increase bone density, not just slow its decline) and lower fracture risk. If they can, the effect seems to be small.

The most effective way to reverse osteoporosis and reduce the risk of fracture is by taking a bisphosphonates (such as alendronate/Fosamax or risedronate/Actonel). Raloxifene (Evista) and estrogen therapy also increase bone density and reduce fracture risk, but their side effects and lower effectiveness (compared with bisphosphonates) make these less-appealing options.

Rabeprazole (Aciphex) is a “proton-pump-inhibitor” (PPI) which reduces acid in the stomach. It can treat ulcers, heartburn and other acid-related stomach disorders. Before blaming rabeprazole for your osteoporosis, keep in mind that in extensive studies of its effectiveness and safety, no link between rabeprazole and osteoporosis was identified. However, limited research has linked PPIs and osteoporosis, possibly due to reduced absorption of calcium. For example, a study published in August 2008 found that adults who had an osteoporosis-related fracture were nearly twice as likely to have taken a PPI for at least seven years.

While it’s possible that PPI use increases the risk of osteoporosis, it’s also possible that people taking PPIs have more risk factors for osteoporosis than those who don’t take PPIs. For example, people taking PPIs may be sicker and more likely to have been admitted to the hospital (where PPIs are often prescribed). Or, they may take less calcium or vitamin D, drink more alcohol, or take corticosteroids more frequently than people who don’t take PPIs.

These other factors (rather than the PPI) could have increased fracture risk. That’s why the study’s authors recommended more research rather than concluding that PPIs caused osteoporosis. One more point: The study did not identify which PPIs were taken by study subjects with osteoporosis-related fractures. So, even if PPIs are found to increase osteoporosis risk, it’s possible that some PPIs (including rabeprazole) have little effect on bone density while others weaken bone more.

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