OSTEOPOROSIS IN POST-

MENOPAUSAL WOMEN
By: Urvi Shah
OSTEOPOROSIS: BACKGROUND
OCCURANCE
1
Occurs when a person loses too much bone mass
or is not producing bone
Osteoporosis is the most prevalent bone disease
10 million people
Half of all Americans over the age of 50 have
Osteoporosis.
One in five elderly people die within a year of a hip
fracture (usually due to Osteoporosis)
High risk population: older adults

SYMPTOMS
2
Early symptoms: usually dont occur
Later symptoms
Back pain from fractured or collapsed vertebra
Loss of height over time
Stooped posture
Bone fractures that occur much more easily than normal
Common: wrist, spine and hip

AVAILABLE TREATMENTS
3
Hormone-Related Therapy
Estrogen/Testosterone
Nutrition: Vitamin D and Calcium
Medications: Bisphosphonates
Alendronate
Risedronate
Ibandronate
Zoledronic Acid
ARTICLE 1: EFFICACY AND SAFETY OF A ONCE-YEARLY INTRAVENOUS
ZOLEDRONIC ACID 5MG FOR FRACTURE PREVENTION IN ELDERLY
POSTMENOPAUSAL WOMEN
WITH OSTEOPOROSIS AGED 75 AND OLDER
4
Journal Of The American Geriatrics Society
Impact factor: 3.987
Grade: A
Multicenter, randomized, double-blind, placebo-
controlled study
3887 participants: post menopausal women
Treatment: Patients were randomized to receive an
intravenous infusion of ZOL 5 mg or placebo. All
patients received calcium (1000-1500 mg) and
vitamin D(400-1200 IU) supplements.
Results: Significant reduction in the risk of new
clinical fractures in group with once-yearly
intravenous ZOL 5mg
THE EFFECT OF 3 VERSUS 6 YEARS OF ZOLEDRONIC ACID
TREATMENT OF OSTEOPOROSIS: A RANDOMIZED EXTENSION TO
THE HORIZON-PIVOTAL FRACTURE TRIAL (PFT)
5
Journal of bone and mineral research
Impact Factor: 6.128
Grade: A
Multi-center, double-blind, placebo-controlled extension
trial
Participants: 1233 post menopausal women
Treatment: extension from 3 years to 6 years in a once-
yearly intravenous infusion of ZOL 5mg or placebo. All
participants took calcium (1000-1500 mg) and vitamin
D(400-1200 IU) supplements
Results: Compared to the 3 year study, most fractures
did not significantly increase or decrease. However, high
risk patients should continue treatment to prevent
vertebral fractures

ZOLEDRONIC ACID: ADVERSE EFFECTS
Headache
Nausea
Fatigue
Flu-like symptoms
Bone pain
Chills

These effects were present in both placebo and
treatment groups. Not significant enough to
discourage treatment.
NUTRITIONAL RECOMMENDATION:
ZOLEDRONIC ACID WITH CALCIUM AND
VITAMIN D SUPPLEMENTATION
Once-yearly intravenous infusion ZOL 5mg
Necessary to have Vitamin D and Calcium
supplementation
Advantages: once a year, no pills, fast

Overall grade of recommendation: A

REFERANCES
1. Osteoporosis Foundation - Facts About Osteoporosis, What is Osteoporosis,
Osteoporosis and Bone Loss. (2013, July 13). Osteoporosis
Foundation. Retrieved December 1, 2013, from
http://www.osteofoundation.org/Facts.html
2. Osteoporosis: Symptoms. (2013, June 21). Mayo Clinic. Retrieved December
1, 2013,
from http://www.mayoclinic.com/health/osteoporosis/DS00128/DSECTI
ON=symptoms
3. Osteoporosis: Treaments. (2013, July 13). Mayo Clinic, Retrieved December 1, 2013,
from http://www.mayoclinic.com/health/osteoporosis/DS00128/DSECTION=
treatments-and-drugs
4. Boonen, Steven, et al. "Efficacy And Safety Of A Once-Yearly Intravenous Zoledronic
Acid 5 Mg For Fracture Prevention In Elderly Postmenopausal Women With
Osteoporosis Aged 75 And Older." Journal Of The American Geriatrics
Society 58.2 (2010): 292-299. Academic Search Premier. Web. 11 Nov. 2013.
5. Black, Dennis M. "The effect of 3 versus 6 years of Zoledronic acid treatment of
osteoporosis: A randomized extension to the HORIZON-Pivotal Fracture Trial
(PFT)." Journal of bone and mineral research 27.2 (2012):243-254.