Prevention of osteoporotic fractures in post-menopausal women.

A number of pharmacological interventions are now available for the prevention of osteoporotic fractures in post-menopausal women. These include hormone 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 fractures at both the spine and the hip, tolerability, side-effects, cost and, in the case of raloxifene and hormone replacement therapy, the extra-skeletal risks and benefits of long-term treatment. The rates of onset and offset of the treatment effect are also important considerations; the observations that relatively short-term intervention produces a significant reduction in fracture risk in women with established osteoporosis, that treatment benefits are greatest in those with low bone mineral density and that the beneficial skeletal effects are not maintained after the withdrawal of treatment have resulted in a shift from long-term preventive strategies towards the targeting of high-risk individuals for intervention.