Controversies in osteoporosis management: How do you treat a newly menopausal woman with low bone mass: When and how is it appropriate to provide pharmacologic intervention to prevent osteoporosis?

摘要

Introduction: Bone loss begins after the age of 30, the time on average when peak bone mass (PBM) is achieved.1 The period of most rapid bone loss in women begins 1 year before the final menses and lasts approximately 3 years, during which time there is a 6% and 7% bone loss at the femoral neck and lumbar spine, respectively.2 As bone microarchitectural changes associated with bone loss are largely irreversible, treatment is unlikely to fully restore the bone strength and quality. The main strategy for prevention of osteoporosis or low bone mass (LBM), therefore, consists of 2 primary approaches: maximizing PBM and minimizing the rate of bone loss. For newly menopausal women with LBM, it is too late to initiate the first approach if their PBM was not optimally achieved; therefore, they may be at higher risk of developing osteoporosis after menopause, even with a typical rate of bone loss (0.5% to 1.5% per year).