Treatment strategies for patients with low bone mass: the younger postmenopausal female

Estimating an individual's fracture risk is the most significant factor for determining the need to initiate bone strengthening treatment in the postmenopausal woman. Fracture risk in inversely and most strongly related to an individual's bone mineral density values, but other factors including age, prior fracture history, body mass index, general health, family history of fractures, corticosteroid use, and smoking history also influence the risk of subsequent fractures. Fracture risk assessment tools such as the World Health Organization's FRAX tool and the Study of Osteoporotic Fractures Index provide 10- and 5-year fracture probability estimates, respectively, and using these tools can be particularly helpful in assessing the immediate need to initiate treatment in younger postmenopausal women. Perimenopausal and postmenopausal bone loss averages about 1% per year with more annual bone loss occurring in trabecular than cortical bone and during a normal life span such bone loss can exceed 35% of an individual's bone mass. Younger postmenopausal women with low bone mineral density values, a history of a previous fracture, greater rates of bone loss as measured by bone turnover markers are more likely to need bone strengthening treatment at an earlier age in the postmenopausal period. Treatment measures include adequate amounts of dietary and supplemental calcium and vitamin D, a routine of regular exercises and medications that reduce the rate of new fractures.