Menopause in Cystic Fibrosis: Special Considerations for Bone Health, Menopausal Symptoms, and Treatment

Cystic fibrosis (CF) is a multisystem autosomal recessive disease arising from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Dysfunction of the CFTR protein leads to progressive pulmonary disease, pancreatic exocrine insufficiency, and nutritional deficiencies. Survival has significantly increased over the last several decades due to improved pulmonary and nutritional management, including CFTR modulator therapy. The adult CF population now faces new challenges of aging, such as menopause-related symptoms and age-related osteoporosis superimposed on underlying CF-related bone disease. The menopausal transition and early postmenopause are characterized by rapid bone loss and represent a window of opportunity to preserve bone mass. Menopausal hormone therapy may alleviate vasomotor symptoms and improve bone density in appropriately selected people. This review will discuss the current knowledge of menopause and bone health in females with CF, address CF-specific considerations on osteoporosis and menopause treatment options, and explore opportunities for future areas of research.