Practical management of postmenopausal women with low bone mineral density

For the management of postmenopausal women with low bone mineral density (BMD), the gynecologist, as a primary care physician, should play a central role in preventing osteoporotic fracture by educating them for elimination of risk factors and for healthy life-style and by providing an appropriate drug therapy. Because the risk of fracture usually increases after BMD decreases as much as 20-30% of peak bone mass, it is practically reasonable to set this level of BMD as a criteria for the initiation of management. As for a drug treatment, it is better to combine estrogen, the first choice drug, with progestogens to counteract any neoplastic effect of unopposed estrogen on the endometrium. Bisphosphonates and calcitonin, which are inhibitors of bone resorption, provide an alternative in prevention and treatment of postmenopausal bone loss in case of contraindication for estrogen or in those women who are unwilling to take estrogen.