Drug prevention and therapeutic program of postmenopausal osteoporosis

Objective: To summarize the present status of study on the drug prevention and therapeutic trials of postmenopausal osteoporosis (PMO) in recent years, so as to investigate the effective prevention and treatment for PMO. Data sources: An online search of Medline database was undertaken by using the keywords of "osteoporosis, postmenopausal, prevention and control, bone density, fractures" to identify the articles about PMO and drug interventions published in English from January 1995 to September 2004. The subjects were females of early menopause or menopause, and the articles should be randomized controlled study. Study selection: After the above search, the trials including intervention and control groups were selected, while the obvious non-randomized trials were excluded, and then the full texts of the selected articles were scanned for randomized controlled study. Inclusion criteria: 1 randomized controlled study with single-blind, double-blind or non-blind method; 2 experiments including parallel control groups; 3 interventional period was above 1 years; 4 samples were more than 100. Exclusion criteria: repetitive experimental study and non-drug intervention. Data extraction: Seventy-seven articles of randomized control study about PMO were collected, 9 of them were trials of drug intervention lasted for more than 1 year. The 68 excluded articles were non-drug interventional studies, repetitive trials or theoretical explorations. Data synthesis: The 9 trials included druginterventions by using bisphosphonatesin, hormone replacement therapy (HRT), calcium and selective estrogen receptor modulators, and non-drug interventions to prevent and treat PMO. Calcium and vitamin D and the derivatives had only weak antiresorptive effects, but they were essential for maintenance of bone strength. HRT could increase bone mineral density (BMD), but it was still not the first choice for prevention of PMO considering its other adverse effects. Alendronate and risedronate were two of the most commonly used bisphosphonatesin for prevention and treatment of PMO, but they should be used with caution in individuals with a history of upper gastrointestinal disease. Several new agents including strontium ranelate and recombined human parathyroid hormone were currently in progress. Conclusion: Drugs can effectively increase the BMD of PMO females, and prevent the occurrence of osteoporotic fracture, it has also been proved to be one of the effective methods for prevention of PMO, but there are not many trials about the drug prevention of PMO. Considering the inconvenience and side effects of some remedies, the selection of preventive medicine of PMO should be combined with the specific condition of the patients.