Management of Osteoporosis in Postmenopausal Women

Abstract

Osteoporosis is a noncommunicable disease with increasing incidence at a global level. The burden of the disease particularly concerns women. A drastic and rapid decline in the circulating levels of estrogens, a key regulator of bone metabolism, is responsible for the increase in bone loss after menopause. Cells with a role in bone metabolism, osteoblasts, osteoclasts and osteocytes, have estrogen receptors. The fall in estrogens increases the differentiation of osteoclasts from progenitors in the bone marrow. A significant expansion in the resorption process follows. Diagnosis is based on anamnesis, which will give information of clinical risk factors. This will allow for the use of absolute risk prediction scales, like FRAX, developed by the World Health Organization. Radiological imaging, particularly dual X-ray absorptiometry (DXA), is also crucial. There are also biochemical markers, although their use in clinical practice is not general. Management should be based on prevention. Healthy lifestyle (restraint from smoking and excessive alcohol, adequate intake of protein and calcium, and physical activity) and hormone therapy, in women with menopausal symptoms, are crucial. Pharmacological drugs are mainly based on anti-resorptives, where selective estrogen receptor modulators (SERMs) may add reduction of breast cancer risk. Bisphosphonates and denosumab should be considered in appropriate cases.