Understanding Risk Factors, Screening, and Treatment of Postmenopausal Osteoporosis: [1]

The elderly are the fastest growing population in the world, and the clinical and public health implications of osteoporosis will steadily increase as the population continues to age. The rising number of osteoporotic fractures will continue to largely impact orthopedic practice, creating a need for better understanding of screening and pharmacologic treatment options.¹

Development of osteoporosis can result from several conditions, including comorbid diseases, risk factors, and postmenopausal estrogen loss. The effects of estrogen on bone mineral density have been heavily studied, and 30% to 50% of American women will endure a clinical fracture during their lifetime due to the loss of bone mineral density that occurs with menopausal estrogen loss.²

Due to the impact that these patients will have on the workload of practitioners, this is the first in a 2-part series on osteoporosis. This article describes risk factors and available treatment options for postmenopausal osteoporosis; part 2 will focus on the risk factors, prevention, and treatment of glucocorticoid-induced osteoporosis.

Depending on the setting in which a physician assumes the care of a patient, the role for providing screening, initial treatment, or continuation of previous treatment may vary, as the orthopedist may not always be the primary care provider.

In the setting of a new postmenopausal fracture, the orthopedist may be the first to screen and initiate therapy for osteoporosis, while in less acute settings, the patient may already have a primary care physician who has addressed these issues.

Risk Factors and Initial Screening

Bone mineral density has long been used as the benchmark for screening and diagnosing osteoporosis, although the World Health Organization (WHO) has identified several other general risk factors. Unpreventable risk factors include female sex, ethnicity and heredity, advanced age, and tall stature. In contrast, preventable risk factors include low body weight, low bone mineral density, fall risk, cigarette smoking, excessive consumption of alcohol, and glucocorticoid use.³

The need to identify patients at high risk for postmenopausal osteoporosis is increasing, but data have been limited and conflicting regarding when and which patients to screen.

The US Preventative Services Task Force (USPSTF) produced recommendations in 2002 that all women ≥65 years be routinely screened for osteoporosis, stating that the benefits of screening/treatment are of moderate magnitude for this patient...