Management of osteoporosis in postmenopausal women: New position statement from NAMS

NAMS released its last position statement on osteoporosis in 2010. Since that time, important advances have been made in the assessment, prevention, and treatment of osteoporosis in postmenopausal women. For example, a preparation containing conjugated estrogens combined with bazedoxifene, rather than a progestin, received approval for osteoporosis prevention, as did three targeted therapies, including two bone-building drugs, for the treatment of women with osteoporosis at high risk of fracture.

According to Dr. Michael McClung, a member of the NAMS board and Co-Lead of the Editorial Panel for the 2021 Osteoporosis Position Statement, NAMS reviewed data on these therapies, as well as on emerging treatment modalities, when drafting its findings. "Education regarding a woman's skeletal health risks is critical during the menopause transition," says Dr. McClung. "The recommendations made in the updated position statement include strategies designed to minimize bone loss as a way to prevent fractures and help women maintain mobility and independence."

Highlights from the 2021 position statement on osteoporosis management include

• Approximately half of women aged 50 years will experience a fracture related to osteoporosis in their lifetimes, often resulting in significant symptoms and impairment of function and quality of life, but the disorder is substantially underdiagnosed and undertreated.
• Estrogen deficiency at menopause is the primary cause of bone loss that leads to osteoporosis.
• Even with optimal general measures such as good nutrition and regular physical activity, osteoporosis progresses with advancing age unless it is treated. Because there is no cure for osteoporosis, life-long management is required once the diagnosis has been made.
• 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, providing justification for the use of the T-score at the hip as an appropriate clinical target guiding choices of therapy.
• Although antiremodeling drugs such as bisphosphonates and denosumab are the drugs chosen to treat most patients with osteoporosis, a new paradigm of beginning treatment with a bone-building agent followed by an antiremodeling agent is recommended for women at very high risk of fracture.

"This new position statement on osteoporosis provides clinicians with a practical guide to assessing and managing bone health in postmenopausal women and emphasizes an individualized approach with regular follow-up and adjustment based on changing clinical needs and patient preference," says Dr. Stephanie Faubion, NAMS medical director.

Reference:

"Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society," is published in Menopause: The Journal of The North American Menopause Society.