TOC for post menopausal osteoporosis is-
Bisphosphonates inhibit bone resorption by binding to hydroxyapatite crystals on the bone surface. When osteo clasts attempt to resorb bone that contains bisphos phonate, the drug is released within the cell, where it inhibits key signalling pathways that are essential for osteoclast function. Although bisphosphonates prima rily target the osteoclast, bone formation is also sup pressed because of coupling between bone formation and bone resorption and an inhibitory effect on osteo blasts. However, the balance of effect on bone turnover is ourable, resulting in a gain in bone density due paly to increased mineralisation of bone. Bisphospho nate treatment typically leads to an increase in spine BMD of about 5-8% and in hip BMD of 2-4% during the f irst 3 years of treatment and plateaus thereafter. Alendronic acid is the bisphosphonate used most fre quently. It reduces risk of veebral fractures by 40% and nonveebral fractures by about 25% in postmenopausal women with osteoporosis. Risedronate is an alternative with similar efficacy, but may be better tolerated in patients with a history of gastrointestinal upset. Both drugs are effective in the treatment of coicosteroid induced osteoporosis. DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-1123
Raloxifene
Tamoxifene
Estrogen
Alendronate
Endocrinology