Osteoporosis Management

The North American Menopause Society has updated its position on postmenopausal osteoporosis management, last issued in 2006. Despite the fact that a number of treatments for osteoporosis have become available over the last few years, physicians still believe that lifestyle and diet are the first line in the prevention of bone loss. The group statement emphasized that all menopausal women should be encouraged to take these measures against bone loss and fractures:

*Maintain a healthy weight

*Eat a balanced diet

*Get enough calcium (from the age of 50 1,200 mg. each day) and vitamin D (800-1,000 IU vitamin D3 each day)

*Exercise regularly

*Avoid drinking lots of alcohol

*Don't smoke

*Take care to prevent falls

10-Year Risk

Since the organization last issued a statement, the 10-year fracture risk calculator, known as FRAX, has been made available, thanks to a World Health Organization meta-analysis of over 60,000 patients and more than 5,000 fractures. The calculator assesses for sex, age, height, weight, low femoral neck bone mineral density, previous fragility fracture, parent's history for hip fracture, smoking status, lengthy corticosteroid use, alcohol consumption, and causes of secondary osteoporosis such as rheumatoid arthritis, type 1 diabetes, and hyperthyroidism. "This tool, used with guidelines for treatment thresholds, is very helpful in identifying candidates for pharmacotherapy," said the position statement.

Treatment Factors

NAMS also included a recommendation that all postmenopausal women with the following factors should be treated with medication for osteoporosis:

*Osteoporotic hip or vertebral fracture

*A bone mineral density T-score of -2.5 or worse at the femoral neck, lumbar spine, or total hip region

* Bone mineral density T-scores that fall below the osteoporotic threshold between -1.0-2.5 if the FRAX risk stands at 20% for major osteoporotic fractures or at least 4% for just hip fracture.

First Line

Bisphosphonates were recommended as the first line of treatment for osteoporosis in women after menopause. Women after menopause with a low bone mass or women in early menopause with osteoporosis may benefit from Evista (raloxifene), a selective estrogen-receptor modulator. NAMS does caution that it is not yet known whether this drug prevents nonvertebral fractures.

Only postmenopausal osteoporotic women who have a high risk for fractures should be treated with Forteo, a parathyroid hormone analogue that necessitates daily subcutaneous injections. This treatment should not be used for longer than 24 months.

Estrogen or combined estrogen/progestogen treatments may work in the early years of menopause where there are moderate to severe symptoms of menopause.

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