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. 2021 Apr;62(4):159-166.
doi: 10.11622/smedj.2021036.

Menopausal osteoporosis: screening, prevention and treatment

Eu-Leong Yong  1   2 , Susan Logan  1   2
Affiliations

Menopausal osteoporosis: screening, prevention and treatment

Eu-Leong Yong et al. Singapore Med J. 2021 Apr.

Abstract

Screening for osteoporosis in women can be based on age and weight, using the Osteoporosis Screening Tool for Asians and assessment for other risk factors such as early menopause, Chinese ethnicity and other secondary factors. Based on the resulting risk profile, women can be triaged to dual-energy X-ray absorptiometry (DEXA) scanning for definite diagnosis of osteoporosis. Treatment should be considered in women with previous fragility fractures, DEXA-diagnosed osteoporosis and high risk of fracture. Exercise improves muscle function, can help prevent falls and has moderate effects on improvements in bone mass. Women should ensure adequate calcium intake and vitamin D. Menopausal hormone therapy (MHT) effectively prevents osteoporosis and fractures, and should be encouraged in those aged < 50 years. For women aged < 60 years, MHT or tibolone can be considered, especially if they have vasomotor or genitourinary symptoms. Risedronate or bisphosphonates may then be reserved for those aged over 60 years.

Keywords: menopause; osteoporosis; prevention; screening; treatment.

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Figures

Fig. 1
Fig. 1
Charts show hip fractures in Singapore from 2000 to 2017 in (a) absolute numbers and (b) age-adjusted rates per 100,000 population. (Reprinted with permission from Springer Nature Customer Service Centre GmbH: Springer Nature, Osteoporosis International, Hip fractures in Singapore: ethnic differences and temporal trends in the new millennium. Yong EL, 2019.)
Fig. 2
Fig. 2
Diagram shows osteoporosis risk stratification for Singapore women based on the Osteoporosis Screening Tool for Asians.(20)
Fig. 3
Fig. 3
Charts show the absolute risks of health outcomes by ten-year age groups in (a) the CEE-MPA trial and (b) the CEE alone trial of the Women’s Health Initiative hormone therapy trials during the intervention phase. (Reproduced with permission from JAMA 2013; 310:1353-68. Copyright © 2013 American Medical Association. All rights reserved.) CEE: conjugated equine oestrogens; MPA: medroxyprogesterone acetate
Box 1
Box 1
Menopausal hormonal therapy (MHT) and osteoporosis by age:
See this image and copyright information in PMC

References

    1. Chandran M, McCloskey EV, Thu WPP, et al. FRAX®based intervention thresholds for management of osteoporosis in Singaporean women. Arch Osteoporos. 2018;13:130. - PubMed
    1. Black DM, Rosen CJ. Clinical practice. Postmenopausal osteoporosis. N Engl J Med. 2016;374:254–62. Erratum in:N Engl J Med 2016; 374:1797. - PubMed
    1. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract. 2020;26:564–70. - PubMed
    1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017:a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–858. Erratum in:Lancet 2019; 393:e44. - PMC - PubMed
    1. Viswanathan M, Reddy S, Berkman N, et al. Screening to prevent osteoporotic fractures:updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;319:2532–51. - PubMed