[Postmenopausal osteoporosis: are there alternatives to estrogen/gestagen substitution?].

This review on non-estrogen measures against postmenopausal osteoporosis first deals with primary prevention in young women, such as calcium rich nutrition and physical training in sedentary young women. For the case of acute osteoporotic vertebral fracture, analgetic, physiotherapeutic and ergonomic measures are highlighted. A more profound discussion covers those possible measures against established osteoporosis, which have been evaluated in prospective controlled trials: calcium, Vitamin-D, fluorides, bisphosphonates, calcitonin, anabolic steroids and exercise. From the currently available studies, the following against established osteoporosis are preferred: Nutrition counselling, motivation for physical exercise and back schooling are sensible in every case. All the other possible interventions, however, are not yet sufficiently substantiated for routine prescription in every case, whether due to lack of proof efficacy for possible adverse side effects, disproportionate costs or other reasons. Thus, for the time being, calcium supplements, Vitamin-D, fluorides, bisphosphonates, calcitonin and anabolic steroids should be reserved for selected, defined cases or for properly controlled prospective studies.