Bisphosphonates

1. Alendronate (Fosamax) has effects comparable to those of estrogen for both the treatment of osteoporosis (10 mg/day or 70 mg once a week) and for its prevention (5 mg/day). Alendronate (in a dose of 5 mg/day or 35 mg/week) can also prevent osteoporosis in postmenopausal women.

2. Risedronate (Actonel), a bisphosphonate, has been approved for prevention and treatment of osteoporosis at doses of 5 mg/day or 35 mg once per week. Its efficacy and side effect profile are similar to those of alendronate.

C. Raloxifene (Evista) is a selective estrogen receptor modulator. It is available for prevention and treatment of osteoporosis. At a dose of 60 mg/day, bone density increases by 2.4 percent in the lumbar spine and hip over a two year period. This effect is slightly less than with bisphosphonates.

D. Calcium. Maintaining a positive calcium balance in postmenopausal women requires a daily intake of 1500 mg of elemental calcium; to meet this most women require a supplement of 1000 mg daily.

E. Vitamin D. All postmenopausal women should take a multivitamin containing at least 400 IU vitamin D daily.

F. Exercise for at least 20 minutes daily reduces the rate of bone loss. Weight bearing exercises are preferable.

References: See page 184.

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