Management of Osteoporosis in Postmenopausal Women

From Menopause
Management of Osteoporosis in Postmenopausal Women: 2010 Position Statement of The North American Menopause Society

Posted: 01/20/2010; Menopause. 2010;17(1):25-54. © 2010 The North American Menopause Society

Objective: To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2006 regarding the management of osteoporosis in postmenopausal women.

Methods: NAMS followed the general principles established for evidence-based guidelines to create this updated document. A panel of clinicians and researchers expert in the field of metabolic bone diseases and/or women's health was enlisted to review the 2006 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees.

Results: Osteoporosis, which is especially prevalent among older postmenopausal women, increases the risk of fractures. Hip and spine fractures are associated with particularly high morbidity and mortality in this population. Given the health implications of osteoporotic fractures, the primary goal of osteoporosis therapy is to prevent fractures, which is accomplished by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to fractures. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. The most common risk factors for osteoporotic fracture are advanced age, low bone mineral density, and previous fracture as an adult. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention.

If pharmacologic therapy is indicated, government-approved options are bisphosphonates, selective estrogen-receptor modulators, parathyroid hormone, estrogens, and calcitonin.

Conclusions: Management strategies for postmenopausal women involve identifying those at risk for fracture, followed by instituting measures that focus on reducing modifiable risk factors through dietary and lifestyle changes and, if indicated, pharmacologic therapy.

Introduction

Osteoporosis becomes a serious health threat for aging postmenopausal women by predisposing them to an increased risk of fracture. Osteoporotic fractures are associated with substantial morbidity and mortality in postmenopausal women, especially older women.

In response to the need to define standards of clinical practice in North America as they relate to menopause-associated health conditions, The North American Menopause Society (NAMS) has created this evidence-based position statement. The objective of this position statement is to provide guidance on the prevention, diagnosis, and treatment of osteoporosis in postmenopausal women to physicians, physician assistants, nurse practitioners, nurses, and other healthcare professionals caring for postmenopausal women, especially those in the clinical practice fields of obstetrics and gynecology, internal medicine, family medicine, and geriatrics.

This position statement is an update of the NAMS position statement published in 2006.[1] Since then, the publication of additional scientific evidence has created a need to update the position statement.

For this revision, NAMS conducted a search of the medical literature published since the previous position statement was submitted for publication in February 2006. A search was made for clinical trials, meta-analyses, and clinical practice guidelines published in English and related to osteoporosis in postmenopausal women, using the MEDLINE database. The Medical Subject Headings (MeSH) used for the search were postmenopausal osteoporosis and bone loss with subheadings for epidemiology, etiology, diagnosis, prevention and control, and therapy. The National Guideline Clearinghouse was searched for relevant clinical practice guidelines, and the Cochrane Library was searched for relevant systematic reviews. Priority was given to evidence from randomized controlled clinical trials and meta-analyses of such trials, followed by evidence from controlled observational studies, using criteria described elsewhere.[2–4] Conclusions from other evidence-based guidelines also were reviewed. Because standards of care and available treatment options differ throughout the world, the focus is limited to therapies available in North America.

To help with this revision, NAMS enlisted a five-person Editorial Board composed of endocrinologists, internists, and rheumatologists from both clinical practice and research with expertise in metabolic bone diseases or women's health. The Editorial Board reviewed the previous position statement and incorporated data published since that statement, compiled supporting statements, and made recommendations. Where the evidence was contradictory or inadequate to form a conclusion, a consensus-based opinion was established. (Practice parameter standards related to NAMS position statements have been described in an editorial.[5]) The NAMS Board of Trustees was responsible for the final review and approval of this document. Updates to this revised position statement will be published as developments occur in scientific research that substantially alters the conclusions.

http://www.medscape.com/viewarticle/714984