A systemic skeletal disorder, osteoporosis is characterised by decreased bone density and deterioration of bone tissue, leading to increased fragility and susceptibility to fractures.¹,² A significant health concern, particularly for postmenopausal women, it is often termed a ‘silent disease’ because bone loss occurs without symptoms until a fracture happens.

Importance of Bone Health

Bone health is essential for maintaining mobility and overall well-being.³ Postmenopausal women are at a higher risk of osteoporosis due to the decline in oestrogen levels, a hormone which plays a crucial role in maintaining bone density. The accelerated bone loss following menopause significantly increases the risk of fractures, particularly in the hip, spine, and wrist.^2,4,5

Preventive Measures

1. Lifestyle Modifications

• Exercise: Engaging in regular weight-bearing and muscle-strengthening exercises can improve bone density, balance, and muscle strength, reducing the risk of falls and fractures.^2,4,6,7
• Diet: A balanced diet rich in calcium and vitamin D is crucial.^2,4 Postmenopausal women should aim for an adequate intake of calcium (around 1200 mg/day)⁴ and vitamin D (800-2000 IU/day), either through diet or supplements.^5,6
• Smoking and alcohol: Avoiding smoking and limiting alcohol intake can help prevent bone loss.^2,4,6,7,8

2. Nutritional Supplementation

• Calcium and vitamin D: Supplements may be necessary for individuals not getting enough from their diet. Vitamin D plays a crucial role in calcium absorption and bone health.^5,6
• Other nutrients: Research suggests that magnesium,⁹ vitamin K,¹⁰ and proteins also play a role in bone health.^7,11

Treatments for Osteoporosis

1. Pharmacological Interventions

• Bisphosphonates: These are the first-line treatment for preventing and treating osteoporosis in postmenopausal women, reducing the risk of fractures by inhibiting bone resorption.^1,5,6,7
• Denosumab: An alternative to bisphosphonates, especially for women with renal impairment or those who cannot tolerate oral bisphosphonates, denosumab is a monoclonal antibody that reduces bone resorption.^1,4,5,6,7
• Selective oestrogen receptor modulators (SERMs): Such as raloxifene, these drugs mimic oestrogen's bone-protective effects.^1,6,7
• Parathyroid hormone analogues: Teriparatide and abaloparatide, these are anabolic treatments that stimulate bone formation, used in severe cases.^1,4,5,6,7
• Romosozumab: A newer option for high-risk patients, which has shown to significantly reduce fracture risk in postmenopausal women with severe osteoporosis.^1,7
• Hormone replacement therapy (HRT): While effective in preventing bone loss, HRT is typically reserved for women with severe symptoms due to associated risks.^1,4,6,7

2. Monitoring and Reassessment

• Bone mineral density (BMD) testing: Regular BMD testing is essential to monitor the effectiveness of treatment and progression of osteoporosis to adjust therapy as needed.^4,7
• Fracture risk assessment: Tools like FRAX can help in assessing fracture risk and guiding treatment decisions.^4,7
• Patient education: Educate patients on medication adherence, potential side effects, and the importance of a healthy lifestyle in managing osteoporosis.⁶

Individualised Approach

Treatment decisions should be individualised based on the patient's risk factors, preferences, comorbidities, and risk of adverse effects. The choice of therapy may also depend on the specific sites of bone loss and the patient's overall risk profile.

References

1. 1. Stevenson J; medical advisory council of the British Menopause Society. Prevention and treatment of osteoporosis in women. Post Reprod Health. 2023 Mar;29(1):11-14. doi:10.1177/20533691221139902. Epub 2022 Nov 10. PMID: 36357006; PMCID: PMC10009319. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10009319/.
   2. Osteoporosis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Available from: https://www.niams.nih.gov/health-topics/osteoporosis#:~:text=Osteoporosis%20is%20called%20a%20%E2%80%9Csilent,or%20hunched%20posture%20(kyphosis).
   3. Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. 6, Determinants of Bone Health. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45503/.
   4. Charde SH, Joshi A, Raut J. A Comprehensive Review on Postmenopausal Osteoporosis in Women. Cureus. 2023 Nov 9;15(11):e48582. doi: 10.7759/cureus.48582. PMID: 38090417; PMCID: PMC10711335. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10711335/.
   5. Cheng CH, Chen LR, Chen KH. Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover. Int J Mol Sci. 2022 Jan 25;23(3):1376. doi: 10.3390/ijms23031376. PMID: 35163300; PMCID: PMC8836058. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836058/.
   6. Keen MU, Reddivari AKR. Osteoporosis in Females. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559156/.
   7. Clinical guideline for the prevention and treatment of osteoporosis. National Osteoporosis Guideline Group UK. 2021. Available from: https://www.nogg.org.uk/full-guideline.
   8. Sampson HW. Alcohol and other factors affecting osteoporosis risk in women. Alcohol Res Health. 2002;26(4):292-8. PMID: 12875040; PMCID: PMC6676684. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676684/.
   9. Rondanelli M, Faliva MA, Tartara A, Gasparri C, Perna S, Infantino V, Riva A, Petrangolini G, Peroni G. An update on magnesium and bone health. Biometals. 2021 Aug;34(4):715-736. doi: 10.1007/s10534-021-00305-0. Epub 2021 May 6. PMID: 33959846; PMCID: PMC8313472. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313472/.
   10. Rodríguez-Olleros Rodríguez C, Díaz Curiel M. Vitamin K and Bone Health: A Review on the Effects of Vitamin K Deficiency and Supplementation and the Effect of Non-Vitamin K Antagonist Oral Anticoagulants on Different Bone Parameters. J Osteoporos. 2019 Dec 31;2019:2069176. doi: 10.1155/2019/2069176. PMID: 31976057; PMCID: PMC6955144. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955144/.
   11. Protein and other nutrients. International Osteoporosis Foundation. Available from: https://www.osteoporosis.foundation/health-professionals/prevention/nutrition/protein-and-other-nutrients#:~:text=The%20role%20of%20protein%20in,and%20muscle%20mass%20with%20ageing.&text=In%20childhood%20and%20adolescence%2C%20protein,role%20in%20bone%20mass%20acquisition.