Year : 2013 | Volume
: 4 | Issue : 2 | Page : 132-
Commentary on guidelines on postmenopausal osteoporosis - Indian Menopause Society
Wulf H Utian
Gynecology and Women's Health, The Cleveland Clinic Chair Scientific Board, RMR Inc. Professor Emeritus, Case Western Reserve University, Visiting Professor, University of Cape Town, Cape Town, South Africa
Wulf H Utian
Gynecology and Women«SQ»s Health, The Cleveland Clinic Chair Scientific Board, RMR Inc. Professor Emeritus, Case Western Reserve University, Visiting Professor, University of Cape Town, Cape Town
|How to cite this article:|
Utian WH. Commentary on guidelines on postmenopausal osteoporosis - Indian Menopause Society.J Mid-life Health 2013;4:132-132
|How to cite this URL:|
Utian WH. Commentary on guidelines on postmenopausal osteoporosis - Indian Menopause Society. J Mid-life Health [serial online] 2013 [cited 2022 Jan 25 ];4:132-132
Available from: https://www.jmidlifehealth.org/text.asp?2013/4/2/132/115299
Osteoporosis was the first genuine long-term major disease proven to be related to menopause. Hip and spine fractures are a major cause of earlier death or painful disability for older women. There are logical and common sense approaches to reducing this epidemic, and the guidelines of the Indian Menopause Society summarize these succinctly and logically.
Because fractures can occur suddenly and without warning, the golden rule is that every woman after menopause should be evaluated for risk factors for osteoporosis. This will include a comprehensive medical history, including use of contemporary questionnaires that help measure the level of risk of a fracture in the future. A physical examination is essential, and some special tests will be necessary. A bone mineral density test, for example, may be indicated, and in this instance country specific guidelines are really essential. There are a number of other laboratory tests that may be needed to identify secondary causes unrelated to menopause.
Risk reduction measures include a healthy diet, exercise, no smoking, and appropriate intake of calcium and vitamin D. In truth, a healthy life-style that pays attention to these activities may be all that is necessary for women after menopause who are at low-risk for fracture.
Calcium and vitamin D on their own will probably not reduce the risk of fracture. Again, country specific guidelines differentiate the needs of different populations.
Once the risk of osteoporotic fracture becomes greater, we are fortunate that a large number of effective therapies have been developed over the last 20 years, and we actually have quite a body of information about them. The medications that work for bone fall into two categories, those that prevent further bone loss (antiresorptive agents), and those that actually build new bone (anabolic agents). The clinical challenge is in selecting the correct and most appropriate drug for each individual woman based on her personal profile.
If you listen to the debate among the experts, you cannot but be surprised by the almost religious fervor they bring to their choice of drug. The truth is that one size does not fit all and like fashion, the time occasionally comes to swap one for another. There is in fact a very logical approach to using drugs to reduce the risk for fractures, assuming of course that there is a justifiable reason for prescribing a pharmacologic agent in the first place and that an individual's risks and benefits have been taken into account.
The important message is that we can identify increased risk for fractures, and adherence to an appropriate health and drug regimen can significantly reduce that risk. The importance of these guidelines cannot be over emphasized, and every practitioner involved in the health-care of older women should read them and heed them.