Image of Stephanie Faubion, M.D.; Image credit: Mayo Clinic

Lifelong treatment is required to keep osteoporosis under control in post-menopausal women, and hormone therapy is often the best choice to prevent further bone loss, according to a new position statement released by the North American Menopause Society (NAMS).

The statement, updated from 2010, covers the most current recommendations for assessment and management of osteoporosis in post-menopausal women. The aim is to provide clinicians with the information they need to identify candidates for osteoporosis drug and supplement therapy, and help patients maintain optimal bone health, the authors said. 

The most effective clinical care will include an individualized approach with regular follow-up and adjustments based on changing clinical needs and patient preference, said Stephanie Faubion, M.D., NAMS medical director.

Highlights of the statement include:

  • Estrogen deficiency at menopause is the primary cause of bone loss that leads to osteoporosis.
  • Whether or not a woman has a healthy lifestyle, osteoporosis progresses with advancing age unless it is treated, and lifelong management is required.
  • Hormone therapy is the most appropriate choice to prevent bone loss at the time of menopause for healthy women, particularly those who have menopause symptoms.
  • Bone mineral density measured while on treatment correlates with the patient’s current risk of fracture. This justifies the use of the T-score at the hip to guide therapy choices.
  • Anti-remodeling drugs such as bisphosphonates and denosumab are the most common choice for treating osteoporosis, but the authors recommend a new paradigm of beginning treatment with a bone-building agent followed by an anti-remodeling agent for women at very high risk of fracture.

Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society” was published in the journal Menopause.