Menopause and bones

Abstract

Osteoporosis is defined as a ‘progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture' (World Health Organisation (WHO) 1994). The clinical relevance of osteoporosis lies in the fractures that arise, resulting in considerable morbidity and financial burden to the National Health Service (NHS). The ageing of the UK population will give rise to a doubling of the number of osteoporotic fractures over the next 50 years if changes to current practice are not implemented. Strategies for the prevention or treatment of osteoporosis include population-based strategies and those targeted to high-risk individuals. It is recommended that the major thrust of prevention of osteoporosis be directed towards selective case finding. Major advances in non-hormonal and hormonal therapeutic agents have led to the development of treatment protocols aimed at fracture reduction. The decision-making process is optimally based around an individual's 10-year risk of fracture as this covers a period over which most current interventions would be used. The assessment of risk in each individual case should take into account their age, fracture history, bone mineral density and other density-independent risk factors for future fracture (e.g. low muscle strength, poor postural stability, etc.). Other features such as the presence or absence of menopausal symptoms would also impact on decisions about management. Once treatment has been initiated, appropriate follow-up is vital in the ongoing management of the individual.