[Risk factors and prevention of postmenopausal osteoporosis]

Preventing postmenopausal bone loss and osteoporotic fractures (vertebral crush fractures and femoral neck fractures) is an important challenge for the next decades. This goal should be achieved by developing screening strategies and deploying established preventive measures. The risk assessment is currently based on densitometric measurements of bone mass and knowledge of risk factors for low bone mass and/or exaggerated bone loss. Hormone replacement therapy is the only well established treatment for preventing osteoporotic fractures. Therefore, it should be recommended to many women. It is important to associate a progesterone derivative with the oestrogen, to exclude patients with breast cancer history and to ensure a follow up by a gynaecologist. Alternative regimens could be useful in patients with low acceptance or contraindication to oestrogens. The long term antifracture efficacy of these molecules remains to be determined, and they have yet, at least in France, no marketing authorization for this purpose.