Postmenopausal Osteoporosis

Abstract

Key Clinical Points

Postmenopausal Osteoporosis

Fragility fractures are very common among postmenopausal women and are associated with increased morbidity, mortality, and health care expenditures.

Dual-energy x-ray absorptiometry (DXA) is recommended in postmenopausal women 65 years of age or older and postmenopausal women younger than 65 years of age who have risk factors.

Osteoporosis is diagnosed on the basis of a fragility fracture or a DXA T score of −2.5 or less.

Treatment of postmenopausal osteoporosis is recommended for patients who have any of the following findings: a fragility fracture (or fractures), particularly of the hip or spine, regardless of the patient’s bone mineral density; a T score of −2.5 or less at the lumbar spine, total hip, or femoral neck; or a high 10-year fracture risk (hip fracture risk of ≥3% or major osteoporotic fracture risk of ≥20%) according to the fracture risk assessment tool (FRAX).

Evaluation should include risk stratification (based on the T score, presence of fractures, and FRAX score) to categorize candidates who meet treatment thresholds as “high risk” or “very high risk.”

The selection of therapy must include consideration of coexisting conditions and contraindications, but anabolic agents are the preferred first line of treatment in women at very high risk.