Tibolone for prevention and treatment of postmenopausal osteoporosis

Tibolone has been widely accepted as remedy for vasomotor symptoms and for prevention of bone loss. Studies over the past 25 years have documented its effects on bone mineral density in younger and older women. Tibolone reduces bone turnover substantially (about the same amount as hormone therapy). Increases in bone mineral density (BMD) accompany this reduction in bone turnover, but like all other antiresorptive therapies, reduction in fracture risk (i.e. 50%) is always greater than would be predicted from BMD change. Finally, as with hormone therapies, dosage reductions have been prompted by new evidence of low dosage efficacy and concern over dose-related side effects. Solid evidence has now emerged from large, dose-ranging studies that the 1.25 mg tibolone dosage is adequate for preservation of BMD and for reduction of fracture risk. Now that fracture efficacy has been added to the list of tibolone's documented bone benefits, physicians must consider this in the overall risks and benefits of its use.