Management of Postmenopausal Osteoporosis

Publication Date: March 31, 2022
Last Updated: March 3, 2023

Objective

Objective

This patient summary means to discuss key recommendations from the American College of Obstetricians and Gynecologists for the Management of 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 is a medical condition that softens bones, increasing their fragility.
  • Osteoporosis most often occurs in postmenopausal women since estrogen is a major promotor of bone growth.
  • Other causes of osteoporosis are type 1 diabetes, improper nutrition, metabolic disorders, liver disease and medications like cortisone.
  • The first symptom is usually a fracture, often from minor impact.
  • This patient summary focuses on the diagnosis and treatment of postmenopausal osteoporosis.

Diagnosis

Diagnosis

  • Dual Energy X-Ray Absorptiometry (DEXA) is the preferred method to determine bone mineral density (BMD).
  • Fractures of hip, humerus, rib, pelvis, wrist or spine after a fall at less than standing height in postmenopausal women indicate bone fragility.
  • Multiple other causes of bone loss must be ruled out before initiating drug treatment.

Treatment

Treatment

  • When your BMD reaches a certain level, treatment is recommended.
    • Lifestyle
      • Weight-bearing exercises
      • Adequate nutrition including:
        • Calcium 1200 mg per day if over 50 years of age
        • Vitamin D 600 IU per day if under 70 years of age
          • 800 IU per day if over 70 years of age
      • Fall prevention
    • Drugs for high-risk patients:
      • Bisphosphonates are usually the first choice.
        • A 3–5 year “drug holiday” is often recommended to prevent excess accumulation of these drugs in bones.
      • Denosumab
        • An injection every 6 months.
        • Should not be interrupted but may be replaced if results are not satisfactory.
      • Raloxifene
        • A second choice option with certain restrictions.
      • Teriparatide and abaloparatide
        • For high-risk patients, a second choice that is limited to 2 years.
      • Romosozumab
        • A second choice that is limited to 2 years with certain restrictions.
  • Treatment for postmenopausal osteoporosis is lifelong.
    • DEXA testing will repeat every 1–3 years.
    • Drug changes or dose adjustments will be based on the progress of your bone health.

Abbreviations

  • BMD: Bone Mineral Density
  • DEXA: Dual Energy X-Ray Absorptiometry
  • IU: International Unit

Source Citation

ACOG Committee on Clinical Practice Guidelines–Gynecology. Management of Postmenopausal Osteoporosis: ACOG Clinical Practice Guideline No. 2. Obstet Gynecol. 2022 Apr 1;139(4):698-717. doi: 10.1097/AOG.0000000000004730. Erratum in: Obstet Gynecol. 2022 Jul 1;140(1):138. PMID: 35594133.

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.