Osteoporosis. Current pharmacologic options for prevention and treatment.

For virtually all asymptomatic postmenopausal women, moderate exercise and supplementation with calcium and vitamin D are recommended. In addition, most postmenopausal women without contraindications would benefit from estrogen replacement therapy, primarily because of its cardiovascular benefits. In patients with contraindications or an aversion to hormone therapy, bone densitometry should be performed to determine risks before expensive nonhormonal treatment is initiated. Therapy with alendronate sodium (Fosamax) or calcitonin (Calcimar, Miacalcin) is clearly indicated in women with established osteoporosis and may be appropriate for early postmenopausal women with osteopenia. Calcitonin is a good option in patients with disabling spinal bone pain. Slow-release sodium fluoride, although still considered experimental, may eventually be given for vertebral fracture in patients with mild to moderate disease.