Management of Osteoporosis in Postmenopausal Women: 2021 Position Statement

Publication Date: August 31, 2021
Last Updated: March 3, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the North American Menopause Society for postmenopausal osteoporosis. This patient summary is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Osteoporosis describes softening of bone that increases the risk of fractures.
    • Vertebrae (spine bones) are the most frequently affected.
  • We will use the abbreviation BMD throughout this summary to refer to bone mineral density.
  • Osteoporosis develops when estrogen production decreases during menopause.
  • There are other causes, such as chronic use of cortisone-like medications, zero gravity, poor nutrition, certain hormonal treatments for cancer and being bedridden.
  • Symptoms rarely appear before a bone breaks.
  • This patient summary focuses on the prevention and treatment of postmenopausal osteoporosis.

Diagnosis

Diagnosis

  • An initial assessment covers not only your general health and medical conditions but also your nutrition, family history, physical activity, alcohol and tobacco use.
  • A bone mineral density (BMD) test (DXA) is usually done.
  • X-rays may also be useful.

Prevention 

Prevention 

  • Lifestyle improvements include optimal nutrition including total daily intake of calcium (1,000-1,200 mg) and vitamin D (400-800 IU), regular physical activity, avoidance of harmful habits like alcohol and smoking, and measures to protect against falling.
    • These measures slow the progression of the condition but do not improve it.

Treatment

Treatment

  • Based on your BMD and other risk factors, early drug treatment added to lifestyle changes is recommended. Choices include:
    • Estrogen alone if you have had your uterus removed.
      • Possibly added progesterone (another female hormone)
    • Raloxifene (modifies estrogen production)
    • A bisphosphonate (stimulates bone growth)
    • Bazedoxifene (stimulates bone growth)
Note: In addition to improving osteoporosis, each of these drugs has its own action profile. Your doctor will discuss each with you to select the best choice.
  • BMD measurements will be repeated every 1-2 years.
    • Changes in treatment will be based on these tests.
  • You may be referred to a specialist if optimum results are not achieved.
  • Expect lifelong management.

Abbreviations

  • BMD: Bone Mineral Density

Source Citation

Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021 Sep 1;28(9):973-997. doi: 10.1097/GME.0000000000001831. PMID: 34448749.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.