Bone health and osteoporosis in postmenopausal women

Osteoporosis-related fractures affect one-third of postmenopausal women, resulting in significant morbidity, mortality and cost. Bone strength is compromised if bone remodelling favours resorption by osteoclasts over bone formation by osteoblasts. Understanding the regulation of remodelling holds the key to the management of osteoporosis. Postmenopausal women should be encouraged to embrace lifestyle changes that benefit bone health. Pharmacological intervention should be reserved for patients at risk of fracture, determined with the 10-year probability of fracture using an integrated model of risk factors (FRAX). Randomized controlled trials have shown that oestrogen/progestin hormone therapy, selective oestrogen receptor modulators, bisphosphonates, teriparatide and strontium ranelate are effective in the prevention of osteoporotic fractures. No head-to-head comparative data are available. Compliance with therapy is poor and treatment monitoring relies on surrogate markers. Every effort must be made to prevent osteoporotic fractures.