title: Bone loss or lost bone: rationale and recommendations for the diagnosis and treatment of early postmenopausal bone loss.
abstract: Recent reports suggest that bone loss begins during late perimenopause at a dramatic rate, even before estrogen levels plummet. During the ensuing 5 years, there is evidence of the beginnings of microarchitectural deterioration, which impacts bone strength and ultimately enhances its propensity to fracture. The diagnosis of osteoporosis based on T-scores alone, or through stratification for a high fracture risk by FRAX, excludes these women who are rapidly losing bone. Because all antiosteoporosis therapies, in particular bisphosphonates, reduce bone loss, we propose aggressive, likely short-term therapy with a goal to reduce bone loss, stabilize bone density, and prevent microarchitectural deterioration.
authors.affiliation: The Mount Sinai Bone Program, Box 1055, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA. mone.zaidi@mssm.edu
authors.forename: Mone
authors.initials: M
authors.lastname: Zaidi
authors.forename: Charles H
authors.initials: CH
authors.lastname: Turner
authors.forename: Ernesto
authors.initials: E
authors.lastname: Canalis
authors.forename: Roberto
authors.initials: R
authors.lastname: Pacifici
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.forename: Jameel
authors.initials: J
authors.lastname: Iqbal
authors.forename: X Edward
authors.initials: XE
authors.lastname: Guo
authors.forename: Stuart
authors.initials: S
authors.lastname: Silverman
authors.forename: Solomon
authors.initials: S
authors.lastname: Epstein
authors.forename: Clifford J
authors.initials: CJ
authors.lastname: Rosen
mesh_terms: D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D016723:Bone Remodeling; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D047648:Perimenopause; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents