What should be done at the time of menopause?

Peak bone mass and aggregate bone loss each contribute to low bone mass found later in life, and obviously the contribution of bone loss will increase as people age. Menopause is the time where bone loss begins to accelerate from the existing peak bone mass. It thus seems obvious that, in order to stratify the female population into groups at various risk, bone mass and rate of loss are the parameters to determine. Which site to measure for the most effective risk assessment has not been determined. All sites seem to give a relatively similar assessment of risk for all subsequent fractures. If the measurement is > 1 standard deviation (SD) above the mean for young normals, no further measurement would be needed and no intervention undertaken. If the measurement is < 1 SD below the mean for young normals, intervention would be recommended (provided no contraindications were present). For those within +/- 1 SD, the rate of loss should be determined. Some individuals lose bone at a more rapid rate than others, and this rapid rate may persist in some of these individuals over a period of years. Studies have shown that women that were classified to be fast losers at menopause have lost approximately 50% more bone mass, at the wrist, spine, and hip within 12 years after menopause than those diagnosed as normal bone losers. The rate of bone loss in postmenopausal women may be indirectly assessed by use of a number of biochemical markers. Fast losers have elevated concentrations of these markers compared with slow bone losers. The risk of developing osteoporosis later in life is thereby determined by combining the values for the present measured bone mass and the magnitude of the estimated future bone loss.