Update on the use of bisphosphonates in the management of postmenopausal osteoporosis by obstetricians-gynecologists.

UNLABELLED: Obstetricians-gynecologists often have a special and long-term relationship with their patients and are ideally placed to assess their fracture risk and to institute appropriate therapy for osteoporosis. Assessment of risk factors according to the World Health Organization and more recent guidelines (e.g., age, smoking history, previous fracture, parental fracture, corticosteroid use, weight) enables the clinician to target patients for testing of bone mineral density by techniques such as dual-energy x-ray absorptiometry at the proximal femur. The current therapy of choice is an oral bisphosphonate, which has proven efficacy in increasing bone mineral density, reducing bone-turnover markers, and reducing fracture rates. Their main drawback is inconvenient dosing requirements, which necessitates taking the drug in the morning at least 30 minutes before the first meal or drink of the day; this may contribute to poor adherence with therapy and suboptimal outcomes. The availability of daily or weekly (alendronate and risedronate) or monthly (ibandronate) bisphosphonates means that patients can have therapy at their preferred frequency, and along with education regarding lifestyle issues such as nutrition, exercise, smoking, and alcohol use, and measures to reduce tripping in the home, should reduce the prevalence of osteoporotic fractures.

TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to recall that there are high-risk fracture patients, explain that Ob/Gyn physicians should target their diagnostic and treatment options to these patients, and state that there are ways that increase compliance to recommended bisphosphonates in addition to the recommended lifestyle changes.