[Management of postmenopausal osteoporosis]

Current management of postmenopausal osteoporosis has benefited from several advances both in the screening or those women with the highest risk of fracture and the development of efficient drugs to reduce the occurrence of fracture. At the individual level, assessment of the risk of fracture must associate the level of bone mineral density which represents the major determinant of fracture and several clinical risk factors. Measurements of biochemical markers of bone turnover are sometimes useful to improving this risk evaluation. However, the 5- to 10-year absolute risk or fracture still needs to be determined as well as the threshold above which a therapeutical intervention should be warranted. Besides hormone replacement therapy, which indications are now more limited than before, the different therapeutical options include several anti-osteoclastic drugs and more recently new anabolic compounds. It should be now possible to anticipate a long term strategy for the prevention of osteoporosis based on an early screening of the women at higher risk of fracture as well as the optimal choice of treatment taking into account the age and underlying clinical conditions of each woman.