Postmenopausal women at high risk of fractures should be treated for osteoporosis

Osteoporosis is often a silent disease and is responsible for minimal trauma fractures in the hip, spine and ribs later in life.

In contrast to senile osteoporosis, osteoporosis occurs much more in the spine in postmenopausal osteoporosis, which is a cancellous bone.  In senile osteoporosis, bones are 50-50, cancellous as well as cortical.  Osteoporosis occurs both in the spine and hip. The commonest fractures in osteoporosis are spine fractures in postmenopausal women followed by fractures in hip and wrist.

The Endocrine Society has published new clinical practice guidelines on the management of osteoporosis in postmenopausal women. The guidelines were presented at ENDO 2019, its annual meeting in New Orleans, La.

Some key recommendations from the guidelines include:

  • Postmenopausal women at high risk of fractures, especially those who have experienced a recent fracture, should receive pharmacological therapies, as the benefits outweigh the risks.
  • Initial treatment with bisphosphonates to reduce fracture risk.
  • Reassess fracture risk after 3-5 years in women taking bisphosphonates.
  • Women who remain at high risk of fractures should continue therapy, while those who are at low-to-moderate risk of fractures should be considered for a “bisphosphonate holiday.”
  • Using denosumab as an alternative to bisphosphonates for the initial treatment of high-risk individuals.
  • Daily calcium and vitamin D supplementation for postmenopausal women at high risk of fracture with osteoporosis who cannot tolerate bisphosphonates, estrogen, selective estrogen response modulators (SERMs), denosumab, tibolone, teriparatide and abaloparatide.
  • Monitor bone mineral density by DEXA spine and hip in postmenopausal women with a low bone mineral density and at high risk of fractures every 1 to 3 years to evaluate response to treatment.

(Source: Endocrine Society News Release, March 25, 2019; J Clin Endocrinol Metab. May 2019;104(5)

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