What's new in preventing and treating osteoporosis?

Women should be encouraged to maintain an adequate calcium intake throughout their life so they have good BMD when they reach menopause. The most effective choice for prevention and treatment of osteoporosis after menopause is estrogen or combined estrogen-progestin. The addition of progestin to estrogen therapy to prevent endometrial cancer does not impair effectiveness of estrogen in increasing BMD. In women who have contraindications to or do not wish to take estrogen, alendronate is the most effective alternative. Raloxifene has been found to protect BMD but not to the extent of estrogen or alendronate, and it does not provide the other benefits offered by estrogen. Calcitonin-salmon has an excellent long-term safety record, but its effectiveness in preventing fracture remains to be fully demonstrated. Adequate calcium intake and exercise are important adjuncts to other therapies but alone do not prevent osteoporosis in most women.