Prevention, diagnosis, and management of osteoporosis-related fracture: A multifactoral osteopathic approach

Journal of the American Osteopathic Association

Volumn 108, Issue 10, 2008, Pages 575-585

  Gronholz, M Jill ^a  

^a Bone Density of North Idaho   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALENDRONIC ACID; CALCITONIN; CALCIUM; COLECALCIFEROL; CYTOTOXIC AGENT; ESTROGEN; GLUCOCORTICOID; HEPARIN; IBANDRONIC ACID; IMMUNOSUPPRESSIVE AGENT; LITHIUM; LOOP DIURETIC AGENT; PARATHYROID HORMONE[1-34]; PLACEBO; RALOXIFENE; RISEDRONIC ACID; TAMOXIFEN; VITAMIN D;

AEROBIC EXERCISE; BACKACHE; BODY HEIGHT; BONE ATROPHY; BONE DENSITOMETRY; BONE DENSITY; BONE RADIOGRAPHY; CARBONATED BEVERAGE; CLINICAL ASSESSMENT; CLINICAL TRIAL; CORTICOSTEROID INDUCED OSTEOPOROSIS; DIET SUPPLEMENTATION; FALL RISK; FRACTURE REDUCTION; FRAGILITY FRACTURE; HIP FRACTURE; HUMAN; IMMOBILIZATION; LIFESTYLE MODIFICATION; MANIPULATIVE MEDICINE; NUTRITIONAL COUNSELING; OSTEOPATHIC MEDICINE; OSTEOPOROSIS; PHYSICAL ACTIVITY; POSTMENOPAUSE; POSTMENOPAUSE OSTEOPOROSIS; REVIEW; RISK FACTOR; RISK REDUCTION; THORACIC SPINE; VERTEBRA FRACTURE; VITAMIN D DEFICIENCY; WEIGHT BEARING; WORLD HEALTH ORGANIZATION; WRIST FRACTURE;

AGED; AGED, 80 AND OVER; FEMALE; FRACTURES, BONE; HEALTH STATUS INDICATORS; HUMANS; MALE; MIDDLE AGED; OSTEOPATHIC MEDICINE; OSTEOPOROSIS; RISK FACTORS;

EID: 55849104261     PISSN: 00986151     EISSN: 00986151     Source Type: Journal    
DOI: None     Document Type: Review

References (90)

1. National Osteoporosis Foundation. America's Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation. Washington, DC: National Osteoporosis Foundation; 2002.
2. Reginster JY, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2006;38(2 suppl 1):S4-S9.
3. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22:465-475.
4. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15:721-739. Available at: http://www.jbmronline.org/doi/full/10.1359/jbmr. 2000.15.4.721. Accessed September 16, 2008.
5. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285:320-323.
6. US Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Office of the Surgeon General; 2004. Available at: http://www.surgeongeneral.gov/library/bonehealth/content.html. Accessed September 16, 2008.
7. Looker AC, Orwoll ES, Johnston CC Jr, Lindsay RL, Wahner HW, Dunn WL, et al. Prevalence of low femoral bone density in older US adults from NHANES III. J Bone Miner Res. 1997;12:1761-1768. Available at: http://www.jbmronline. org/doi/full/10.1359/jbmr.1997.12.11.1761. Accessed September 16, 2008.
8. Gruntmanis U. Male osteoporosis: deadly, but ignored. Am J Med Sci. 2007;333:85-92.
9. Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, et al. Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med. 2003;163:2052-2057. Available at: http://archinte.ama-assn.org/cgi/content/full/163/17/2052. Accessed September 16, 2008.
10. Gehlbach SH, Fournier M, Bigelow C. Recognition of osteoporosis by primary care physicians. Am J Public Health. 2002;92:271-273. Available at: http://www.ajph.org/cgi/content/full/92/2/271. Accessed September 16, 2008.
11. Stafford RS, Drieling RL, Hersh AL. National trends in osteoporosis visits and osteoporosis treatment, 1988-2003. Arch Intern Med. 2004;164:1525-1530. Available at: http://archinte.ama-assn.org/cgi/content/full/ 164/14/1525. Accessed September 16, 2008.
12. Gallagher TC, Geling O, Comite F. Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med. 2002;162:450-456. Available at: http://archinte.ama-assn.org/cgi/content/full/162/4/450. Accessed September 16, 2008.
13. Follin SL, Black JN, McDermott MT. Lack of diagnosis and treatment of osteoporosis in men and women after hip fracture. Pharmacotherapy. 2003;23:190-198.
14. Neuner JM, Zimmer JK, Hamel MB. Diagnosis and treatment of osteoporosis in patients with vertebral compression fractures. J Am Geriatr Soc. 2003;51:483-491.
15. Feldstein AC, Nichols GA, Elmer PJ, Smith DH, Aickin M, Herson M. Older women with fractures: patients falling through the cracks of guideline-recommended osteoporosis screening and treatment. J Bone Joint Surg Am. 2003;85A:2294-2302.
16. Kamel HK, Hussain MS, Tariq S, Perry HM, Morley JE. Failure to diagnose and treat osteoporosis in elderly patients hospitalized with hip fracture. Am J Med. 2000;109:326-328.
17. Solomon DH, Finkelstein JS, Katz JN, Mogun H, Avorn J. Underuse of osteoporosis medications in elderly patients with fractures. Am J Med. 2003;115:398-400.
18. National Osteoporosis Foundation. Physician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2003.
19. Hodgson SF, Watts NB, Bilezikian JP, Clarke BL, Gray TK, Harris DW, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. 2003;9:544-564. Available at: http://www.aace.com/pub/pdf/guidelines/ osteoporosis 2001Revised.pdf. Accessed September 16, 2008.
20. Saag KG, Morgan SL, Coa X. Bone health and disease. In: Koopman WJ, Moreland LW, eds. Arthritis and Allied Conditions: A Textbook of Rheumatology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2005:2487.
21. Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD. Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone. 2003;32:78-85.
22. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR; for the Study of Osteoporotic Fractures Research Group. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res. 1999;14:821-828. Available at: http://www.jbmronline.org/doi/ full/10.1359/jbmr.1999.14.5.821. Accessed September 16, 2008.
23. Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35:375-382.
24. Espallargues M, Sampietro-Colom L, Estrada MD, Sola M, del Rio L, Setoain J, et al. Identifying bone-mass-related risk factors for fracture to guide bone densitometry measurements: a systematic review of the literature. Osteoporos Int. 2001;12:811-822.
25. Epstein S, Inzerillo AM, Caminis J, Zaidi M. Disorders associated with acute rapid and severe bone loss. J Bone Miner Res. 2003;18:2083-2094. Available at: http://www.jbmronline.org/doi/full/10.1359/jbmr.2003.18.12.2083. Accessed September 16, 2008.
26. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapies [review]. JAMA. 2001;285:785-795.
27. Schuit SC, van der Klift M, Weel AE, de Laet CE, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004;34:195-202.
28. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254-1259. Available at: http://www.bmj.com/cgi/content /full/312/7041/1254. Accessed September 16, 2008.
29. World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129.
30. Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, et al. Assessment of fracture risk [published online ahead of print December 23, 2004]. Osteoporos Int. 2005;16:581-589.
31. Ruff CB. Gracilization of the modern human skeleton. Am Sci. 2006;94:508-514. Available at: http://www.americanscientist.org/template/ AssetDetail/assetid/54066. Accessed September 16, 2008.
32. Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164:1108-1112. Available at: http://archinte.ama-assn.org/cgi/content/full/164/10/1108. Accessed September 16, 2008.
33. Taylor BC, Schreiner PJ, Stone KL, Fink HA, Cummings SR, Nevitt MC, et al. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc. 2004;52:1479-1486.
34. Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, et al. An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int. 2001;12:519-528.
35. Cadarette SM, McIsaac WJ, Hawker GA, Jaakkimainen L, Culbert A, Zarifa G, et al. The validity of decision rules for selecting women with primary osteoporosis for bone mineral density testing [published online ahead of print January 17, 2004]. Osteoporos Int. 2004;15:361-366.
36. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ. 2000;162:1289-1294. Available at: http://www.cmaj.ca/cgi/content/full/162/9/ 1289. Accessed September 16, 2008.
37. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk [review]. Lancet. 2002;359:1929-1936.
38. Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, et al. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med. 1991;324:1326-1331.
39. American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49:664-672. Available at: http://www.americangeriatrics.org/products/positionpapers/Falls.pdf. Accessed September 16, 2008.
40. Link TM, Guglielmi G, van Kuijk V, Adams JE. Radiologic assessment of osteoporotic vertebral fractures: diagnostic and prognostic implications. Eur Radiol. 2005;15:1521-1532.
41. Bouxsein ML, Kaufman J, Tosi L, Cummings S, Lane J, Johnell O. Recommendations for optimal care of the fragility fracture patient to reduce the risk of future fracture. J Am Acad Orthop Surg. 2004;12:385-395.
42. Krege JH, Siminoski K, Adachi JD, Misurski DA, Chen P. A simple method for determining the probability a new vertebral fracture is present in post-menopausal women with osteoporosis [published online ahead of print November 22, 2005]. Osteoporos Int. 2006;17:379-386.
43. Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ III. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res. 1992;7:221-227.
44. Ross PD. Clinical consequences of vertebral fractures [review]. Am J Med. 1997;103(2A):30S-43S.
45. Tamayo-Orozco J, Arzac-Palumbo P, Peon-Vidales H, Mota-Bolfeta R, Fuentes F. Vertebral fractures associated with osteoporosis: patient management. Am J Med. 1997;103(2A):44S-50S.
46. Mui LW, Haramati LB, Alterman DD, Haramati N, Zelefsky MN, Hamerman D. Evaluation of vertebral fractures on lateral chest radiographs of innercity postmenopausal women [published online ahead of print October 2, 2003]. Calcif Tissue Int. 2003;73:550-554.
47. Solomon DH, Morris C, Cheng H, Cabral D, Katz JN, Finkelstein JS, et al. Medication use patterns for osteoporosis: an assessment of guidelines, treatment rates, and quality improvement interventions. Mayo Clin Proc. 2005;80:194-202. Available at: http://www.mayoclinicproceedings.com/inside.asp? AID=831&UID=. Accessed September 16, 2008.
48. Lindsay R, Borisov NN, Sheer RL, Steinbuch M. Impact of early osteoporosis treatment on subsequent fracture prevention among women with clinical vertebral fracture. Abstract presented at: Annual Meeting of the American Society for Bone and Mineral Research; September 23-27, 2005; Nashville, Tenn. M293.
49. Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223-1238.
50. Brecher LS, Pomerantz SC, Snyder BA, Janora DM, Klotzbach-Shimomura KM, Cavalieri TA. Osteoporosis prevention project: a model multidisciplinary educational intervention. J Am Osteopath Assoc. 2002;102:327-335. Available at: http://www.jaoa.org/cgi/reprint/102/6/327. Accessed September 16, 2008.
51. Pearson JA, Burkhart E, Pifalo WB, Palaggo-Toy T, Krohn K. A lifestyle modification intervention for the treatment of osteoporosis. Am J Health Promot. 2005;20:28-33.
52. Chang JT, Morton SC, Rubenstein LZ, Mojica WA, Maglione M, Suttorp MJ, et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328:680. Available at: http://www.bmj.com/cgi/content/full/328/7441/680. Accessed September 16, 2008.
53. Capezuti E, Taylor J, Brown H, Strothers HS III, Ouslander JG. Challenges to implementing an APN-facilitated falls management program in long-term care. Appl Nurs Res. 2007;20:2-9.
54. Szulc P, Garnero P, Claustrat B, Marchand F, Duboeuf F, Delmas PD. Increased bone resorption in moderate smokers with low body weight: the Minos Study. J Clin Endocrinol Metab. 2002;87:666-674. Available at: http://jcem.endojournals.org/cgi/content/full/87/2/666. Accessed September 16, 2008.
55. Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 2007;297:387-394.
56. Kocjan T, Tan TM, Conway GS, Prelevic G. Vitamin D status in patients with osteopenia or osteoporosis - an audit of an endocrine clinic. Int J Vitam Nutr Res. 2006;76:307-313.
57. Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992;327:1637-1642.
58. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337:670-676.
59. Recker RR, Hinders S, Davies KM, Heaney RP, Stegman MR, Lappe JM, et al. Correcting calcium nutritional deficiency prevents spine fractures in elderly women. J Bone Miner Res. 1996;11:1961-1966.
60. Armas LAG, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab. 2004;89:5387-5391. Available at: http://jcem.endojournals.org/cgi/content/full/89/11/5387. Accessed September 16, 2008.
61. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials [review]. JAMA. 2005;293:2257-2264.
62. Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr. 2006;84:936-942.
63. Gregg EW, Pereira MA, Caspersen CJ. Physical activity, falls, and fractures among older adults: a review of the epidemiologic evidence. J Am Geriatr Soc. 2000;48:883-893.
64. Liu-Ambrose T, Khan KM, Eng JJ, Janssen PA, Lord SR, McKay HA. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J Am Geriatr Soc. 2004;52:657-665.
65. Kerr D, Ackland T, Maslen B, Morton A, Prince R. Resistance training over 2 years increases bone mass in calcium-replete postmenopausal women. J Bone Miner Res. 2001;16:175-181. Available at: http://www.jbmronline.org/doi/ full/10.1359/jbmr.2001.16.1.175. Accessed September 16, 2008.
66. Milliken LA, Going SB, Houtkooper LB, Flint-Wagner HG, Figueroa A, Metcalfe LL, et al. Effects of exercise training on bone remodeling, insulin-like growth factors, and bone mineral density in postmenopausal women with and without hormone replacement therapy [published online ahead of print February 10, 2003]. Calcif Tissue Int. 2003;72:478-484.
67. Bonner FJ Jr, Sinaki M, Grabois M, Shipp KM, Lane JM, Lindsay R, et al. Health professional's guide to rehabilitation of the patient with osteoporosis. Osteoporos Int. 2003;14(suppl 2):S1-S22.
68. Devine WH, Ross JS. Osteopathic medicine's approach to managing osteoporosis. AOA's Women and Wellness. 2004;1(2):4-5. Available at: http://www.cecity.com/aoa/women_well/sep_04/print1.pdf. Accessed September 16, 2008.
69. Kannus P, Parkkari J, Niemi S, Pasanen M, Palvanen M, Jarvinen M, et al. Prevention of hip fracture in elderly people with use of a hip protector. N Engl J Med. 2000;343:1506-1513.
70. Birks YF, Hildreth R, Campbell P, Sharpe C, Torgerson DJ, Watt I. Randomised controlled trial of hip protectors for the prevention of second hip fractures. Age Ageing. 2003;32:442-444. Available at: http://ageing.oxfordjournals.org/cgi/reprint/32/4/442. Accessed September 16, 2008.
71. Cameron ID, Cumming RG, Kurrle SE, Quine S, Lockwood K, Salkeld G, et al. A randomised trial of hip protector use by frail older women living in their own homes. Inj Prev. 2003;9:138-141.
72. van Schoor NM, Smit JH, Twisk JW, Bouter LM, Lips P. Prevention of hip fractures by external hip protectors: a randomized controlled trial. JAMA. 2003;289:1957-1962.
73. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fraction Intervention Trial Research Group. Lancet. 1996;348:1535-1541.
74. Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metab. 2000;85:4118-4124. Available at: http://jcem.endojournals.org/cgi/content/full/85/11/4118. Accessed September 16, 2008.
75. Chesnut CH III, Silverman S, Andriano K, Genant H, Gimona A, Harris S, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence of Osteoporotic Fractures Study. PROOF Study Group. Am J Med. 2000;109:267-276.
76. Chesnut CH III, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004;19:1241-1249. Available at: http://www.jbmronline.org/doi/full/10.1359/ JBMR.040325. Accessed September 16, 2008.
77. Ringe JD, Dorst A, Faber H, Ibach K, Sorenson F. Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis: results from a long-term comparative study. Osteoporos Int. 2003;14:801-807.
78. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators [published correction appears in JAMA. 1999;282:2124]. JAMA. 1999;282:637-645.
79. Maricic M, Adachi JD, Sarkar S, Wu W, Wong M, Harper KD. Early effects of raloxifene on clinical vertebral fractures at 12 months in postmenopausal women with osteoporosis. Arch Intern Med. 2002;162:1140-1143. Available at: http://archinte.ama-assn.org/cgi/content/full/162/10/1140. Accessed September 16, 2008.
80. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344-1352.
81. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int. 2000;11:83-91.
82. Roux C, Seeman E, Eastell R, Adachi J, Jackson RD, Felsenberg D, et al. Efficacy of risedronate on clinical vertebral fractures within six months. Curr Med Res Opin. 2004;20:433-439.
83. Harrington JT, Ste-Marie LG, Brandi ML, Civitelli R, Fardellone P, Grauer A, et al. Risedronate rapidly reduces the risk for nonvertebral fractures in women with postmenopausal osteoporosis [published online ahead of print December 5, 2003]. Calcif Tissue Int. 2004;74:129-135.
84. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344:1434-1441.
85. North American Menopause Society. Management of osteoporosis in postmenopausal women: 2006 position statement of The North American Menopause Society. Menopause. 2006;13:340-367.
86. Boonen S, Laan RF, Barton IP, Watts NB. Effects of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies. Osteoporos Int. 2005;16:1291-1298.
87. Pols HA, Felsenberg D, Hanley DA, Stepan J, Munoz-Torres M, Wilkin TJ, et al. Multinational, placebo-controlled, randomized trial of the effects of alendronate on bone density and fracture risk in postmenopausal women with low bone mass: results of the FOSIT study. Fosamax International Trial Study Group. Osteoporos Int. 1999;9:461-468.
88. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004;291:1701-1712.
89. Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix AZ, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women's Health Initiative randomized trial. JAMA. 2003;290:1729-1738.
90. Chen P, Miller PD, Delmas PD, Misurski DA, Krege JH. Change in lumbar spine BMD and vertebral fracture risk reduction in teriparatide-treated post-menopausal women with osteoporosis. J Bone Miner Res. 2006;21:1785-1790. Available at: http://www.jbmronline.org/doi/full/10.1359/ jbmr.060802. Accessed September 16, 2008.