title: Recommendations on the management of fragility fracture risk in women younger than 70 years.
abstract: The risk for fragility fracture represents a problem of enormous magnitude. It is estimated that only a small fraction of women with this risk take the benefit of preventive measures. The relationship between estrogen and bone mass is well known as they are the other factors related to the risk for fracture. There are precise diagnostic methods, including a tool to diagnose the risk for fracture. Yet there continues to be an under-diagnosis, with the unrecoverable delay in instituting preventive measures. Women under the age of 70 years, being much more numerous than those older, and having risk factors, are a group in which it is essential to avoid that first fragility fracture. Today it is usual not to differentiate between the treatment and the prevention of osteoporosis since the common aim is to prevent fragility fractures. Included in this are women with osteoporosis or with low bone mass and increased risk for fracture, for whom risk factors play a primary role. There is clearly controversy over the type of treatment and its duration, especially given the possible adverse effects of long-term use. This justifies the concept of sequential treatment, even more so in women under the age of 70, since they presumably will need treatment for many years. Bone metabolism is age-dependent. In postmenopausal women under 70 years of age, the increase in bone resorption is clearly predominant, related to a sharp drop in estrogens. Thus a logical treatment is the prevention of fragility fractures by hormone replacement therapy (HRT) and, in asymptomatic women, selective estradiol receptor modulators (SERMs). Afterwards, there is a period of greater resorption, albeit less intense but continuous, when one could utilise anti-resorptive treatments such as bisphosphonates or denosumab or a dual agent like strontium ranelate. Bone formation treatment, such as parathyroid hormone (PTH), in women under 70 years will be uncommon. That is because it should be used in cases where the formation is greatly diminished and there is a high risk for fracture, something found in much older women.
authors.affiliation: Instituto Palacios, Salud y Medicina de la Mujer, C/ Antonio Acuña, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Palacios
authors.forename: Claus
authors.initials: C
authors.lastname: Christiansen
authors.forename: Rafael
authors.initials: R
authors.lastname: Sánchez Borrego
authors.forename: Marco
authors.initials: M
authors.lastname: Gambacciani
authors.forename: Payman
authors.initials: P
authors.lastname: Hadji
authors.forename: Morten
authors.initials: M
authors.lastname: Karsdal
authors.forename: Irene
authors.initials: I
authors.lastname: Lambrinoudaki
authors.forename: Stefano
authors.initials: S
authors.lastname: Lello
authors.forename: Barbara
authors.initials: B
authors.lastname: O'Beirne
authors.forename: Fatima
authors.initials: F
authors.lastname: Romao
authors.forename: Serge
authors.initials: S
authors.lastname: Rozenberg
authors.forename: John C
authors.initials: JC
authors.lastname: Stevenson
authors.forename: Zion
authors.initials: Z
authors.lastname: Ben-Rafael
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000517:prevention & control; D004967:Estrogens / Q000378:metabolism / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D014943:Global Health; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D017698:Postmenopause; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004967:Estrogens