Menopause and osteoporosis: Epidemiology, pathophysiology, screening and diagnosis

Osteoporosis is a silent disease disproportionately affecting women during peri- and postmenopause due to the associated reduction in oestrogen. It incurs a high fragility fracture risk and financial costs to society. General practitioners (GPs) are well placed to detect this, diagnose it and reduce the subsequent burden of disease.

To equip GPs with the understanding of the extent of the disease, pathophysiology and why early detection matters; while further developing screening and diagnostic skills to identify osteoporosis, especially in high-risk women.

Osteoporosis is the result of resorption- formation uncoupling driven by oestrogen reduction during menopause. The incidence of osteoporosis is increasing. Screening to prevent fractures is essential, especially where risk factors, with a prior fracture being the biggest risk for future fractures, are present. Diagnosis on dual-energy X-ray absorptiometry (DXA) (although not always Medicare reimbursed) is with T-score ≤-2.5. X-rays can complement the work-up because a fragility fracture substantiates a diagnosis.