Assessment and hormonal management of osteoporosis

Abstract

Postmenopausal osteoporosis is a frequent health issue in women. Because osteoporosis-related fractures cause a significant increase in mortality and morbidity, it is clinically important to identify as soon as possible women at increased risk for future fracture so that preventive measures can be instituted. At the beginning of menopause, evaluation of the subsequent risk of fracture is not so easy. Most screening tools fail to accurately identify those women who will fracture within the next 10 years. A history of a prior fracture and low bone mineral density are the only major consistently found predictors for the risk of fracture. On the other hand, it is no longer a question whether menopause hormone therapy is efficient not only to prevent postmenopausal bone loss but also the incidence of fragility fracture. Over the last years, utility of menopause hormone therapy for the prevention of osteoporosis has been questioned due to safety concerns. In light of the most recent reports on a more favorable benefit/risk balance than was initially claimed in early postmenopausal women, this needs to be reconsidered. Prevention of bone loss in those women with a moderate or slightly high risk of fracture is likely a strategy to reduce fracture risk in older women. Menopause hormone therapy must be considered as a true primary preventive therapy more than an anti-fracture therapy at an age when the risk of fracture is likely much lower than later in life. Only thereafter should other anti-osteoporotic medications be discussed in women still at high risk for fracture.

摘要

绝经后女性骨质疏松症是一个常见的健康问题。因为骨质疏松症相关的骨折死亡率和发病率明显增加, 临床上重要的是尽快确定未来骨折风险高的女性, 以便采取预防措施。在绝经早期, 评估随后发生骨折的风险并不容易。大多数筛查工具不能准确识别未来10年内将会发生骨折的女性。骨折史和低骨密度史是唯一能够预测骨折风险的主要因素。另一方面, 绝经激素治疗是否有效预防绝经后骨质流失、降低脆性骨折的发病率不再是一个问题。在过去几年里, 由于安全性问题, 绝经激素治疗用于预防骨质疏松症的效用遭到了质疑。根据最近关于有利的获益/风险平衡的报告, 比最初在绝经早期女性中声称的更好, 这需要重新考虑。在骨折风险中度或稍高的女性中预防骨质流失可能是降低老年女性骨折风险的策略。绝经激素治疗必须被视为真正的一级预防疗法, 而不是抗骨折治疗, 因为骨折风险于生命后期更高。只有在绝经激素治疗之后才应该考虑对骨折风险仍高的女性进行其他抗骨质疏松的药物治疗。

Keywords:

• Postmenopausal osteoporosis
• risk of fracture
• screening tools
• primary prevention
• menopausal hormone therapy