Osteoporosis as a model for the long-term clinical consequences of the menopause

The decrease in ovarian function culminating in the last menstrual period, the menopause, in women in their forties and fifties takes place over a period of 3 to 5 years. There are several immediate clinical consequences of the menopause that are easy to detect and treat, usually with hormone replacement. In contrast, the longer term consequences of the menopause, cardiovascular disease and osteoporosis, are usually clinically silent during these early postmenopausal years. As a result, it has proven difficult to get physicians and their patients to accept this cause-and-effect relationship between the menopause and the development of osteoporosis or heart disease a decade or more later. The details concerning the menopause and osteoporosis are by now so well established that this disease can serve as a model for studies linking the menopause to heart disease. This article, with its focus on osteoporosis, serves as an introduction to the later articles detailing the cardiovascular consequences of the menopause.