Strategies for the prevention and treatment of osteoporosis during early postmenopause.
During the perimenopause, both the quantity and quality of bone decline rapidly, resulting in a dramatic increase in the risk of fracture in postmenopausal women. Although many factors are known to be associated with osteoporotic fractures, measures to identify and treat women at risk are underused in clinical practice. Consequently, osteoporosis is frequently not detected until a fracture occurs. Identification of postmenopausal women at high risk of fracture therefore is a priority and is especially important for women in early postmenopause who can benefit from early intervention to maintain or to increase bone mass and, thus, reduce the risk of fracture. Most authorities recommend risk-factor assessment for all postmenopausal women, followed by bone mineral density measurements for women at highest risk (ie, all women aged > or =65 years, postmenopausal women aged <65 years with > or =1 additional risk factors for osteoporosis, and postmenopausal women with fragility fractures). All postmenopausal women can benefit from nonpharmacologic interventions to reduce the risk of fracture, including a balanced diet with adequate intake of calcium and vitamin D, regular exercise, measures to prevent falls or to minimize their impact, smoking cessation, and moderation of alcohol intake. Several pharmacologic agents, including the bisphosphonates (eg, alendronate, risedronate, and ibandronate) and the selective estrogen receptor modulator, raloxifene, have been shown to increase bone mass, to reduce fracture risk, and to have acceptable side-effect profiles. Women who have discontinued hormone therapy are in particular need of monitoring for fracture risk, in light of the accelerated bone loss and increased risk of fracture that occurs after withdrawal of estrogen treatment.
Delaney
Miriam F
MF
Center for Osteoporosis and Metabolic Bone Diseases, Rheumatology Division, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. delanem@ccf.org
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D019386:Alendronate / Q000494:pharmacology / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D002116:Calcitonin / Q000494:pharmacology / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D004164:Diphosphonates / Q000494:pharmacology / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D012968:Etidronic Acid / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D008019:Life Style; D008159:Lumbar Vertebrae / Q000502:physiology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D010281:Parathyroid Hormone / Q000494:pharmacology / Q000627:therapeutic use; D047648:Perimenopause / Q000502:physiology; D000068296:Risedronic Acid; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology / Q000627:therapeutic use; D012907:Smoking / Q000453:epidemiology; D014807:Vitamin D / Q000008:administration & dosage
D002136:Calcium, Dietary; D004164:Diphosphonates; D010281:Parathyroid Hormone; D020845:Selective Estrogen Receptor Modulators; D014807:Vitamin D; D002116:Calcitonin; D000068296:Risedronic Acid; D012968:Etidronic Acid; D000077557:Ibandronic Acid; D019386:Alendronate