Menopausal osteoporosis: screening, prevention and treatment

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.

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

Diagram shows osteoporosis risk stratification for Singapore women based on the Osteoporosis Screening Tool for Asians.(20)

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

Menopausal hormonal therapy (MHT) and osteoporosis by age: