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Osteoporosis greatly increases the risk of fracture for postmenopausal women, especially older women.
Osteoporosis greatly increases the risk of fracture for postmenopausal women, especially older women. Hip and spine fractures in older patients cause significant morbidity and mortality. Treatment of osteoporosis aims primarily to prevent fractures by decreasing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors that increase the risk of fracture.
To guide healthcare providers about effective management of postmenopausal women with osteoporosis, The North American Menopause Society (NAMS) has updated its 2006 evidence-based position statement in light of subsequently published scientific data. NAMS recruited a panel of clinicians and researchers in metabolic bone disease and women's health to review the 2006 statement, compile supporting statements, and reach a 2010 consensus on recommendations.
These highlights of the new position statement can help you manage your postmenopausal patients with osteoporosis. The full text ("Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society") is available on the NAMS Web site at http://www.menopause.org/psosteo10.pdf.
Managing osteoporosis begins with assessing risk factors for the condition, defined by bone mineral density (BMD), and for osteoporotic fracture. Significant risk factors for osteoporosis include advanced age, genetics, lifestyle, thinness, and menopause status; the most common risks for fracture are advanced age, low BMD, and previous fracture as an adult. Evaluation should include a history, physical examination, and diagnostic tests.
History. Collect information about clinical risk factors, including the World Health Organization's Fracture Risk Assessment Tool (FRAX) factors (fracture after 40 years of age, hip fracture in a parent, cigarette smoking, excessive alcohol consumption, and secondary causes of osteoporosis and fragility fracture such as glucocorticoid use and rheumatoid arthritis).
Calcium and vitamin D intake and lifestyle factors such as diet, exercise, smoking, and drinking should be reviewed periodically. Evaluate the risk of falls annually and whenever the patient's physical and mental status change.
Physical examination. Measure height and weight annually to assess for height loss of more than 1.5 inches (3.8 cm)-which may indicate vertebral fracture-and low body mass index (BMI) or weight changes, which can hinder evaluation of changes in BMD. Also assess for chronic back pain, kyphosis, and clinical risk factors.
BMD testing. All postmenopausal women with medical causes of bone loss and all women 65 years and older should undergo BMD testing. Also consider testing women 50 years old and older who have at least 1 of the following risk factors:
Dual-energy x-ray absorptiometry (DXA) of the total hip, femoral neck, and posterior-anterior lumbar spine, using the lowest of the 3 BMD scores, is the preferred method of measuring BMD. A T-score of –2.5 or lower indicates osteoporosis.
Confirming vertebral fracture. Confirmation must be obtained by lateral spine radiographs or vertebral fracture assessment visualization at the time of BMD testing. Vertebral fracture is confirmed by height loss greater than 20% of the anterior, mid, or posterior dimension of a vertebra.