NAMS updates position statement on osteoporosis in postmenopausal women
NAMS has released a position statement reflecting the latest thinking and findings regarding the management of osteoporosis in postmenopausal women.
“Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society” considers risk factors and available risk-assessment tools for identifying candidates for pharmacologic therapy, as well as clarifies appropriate intakes of calcium, vitamin D and protein to maintain bone health, the organization said.
Since its last position statement on osteoporosis in 2010, there have been important advances in assessing, preventing and treating osteoporosis in postmenopausal women, according to NAMS. For example, a preparation including conjugated estrogens combined with bazedoxifene instead of a progestin has been approved for osteoporosis prevention. In addition, three targeted therapies — including two bone-building drugs — have been approved to treat women with osteoporosis at high risk for fracture.
NAMS reviewed data on these therapies and on emerging treatment modalities in drafting its position statement, Michael R. McClung, MD, FACP, FACE, a member of the NAMS board and co-lead of the 2021 Osteoporosis Position Statement Editorial Panel, said in a press release.
“Education regarding a woman’s skeletal health risks is critical during the menopause transition,” said McClung. “The recommendations made in the updated position statement include strategies designed to minimize bone loss as a way to prevent fractures and help women maintain mobility and independence.”
According to the position statement, about half of all women aged older than 50 years will experience a fracture related to osteoporosis. Despite these fractures, which often result in significant impairment of function and quality of life, the disorder is substantially underdiagnosed and undertreated.
Also, according to NAMS, estrogen deficiency at menopause is the primary cause of bone loss leading to osteoporosis. Osteoporosis progresses with advancing age unless it is treated, even if general measures are taken like good nutrition and regular physical activity. There is no cure for osteoporosis, so lifelong management is required once the diagnosis has been made.
Hormone therapy is the most appropriate choice to prevent bone loss at the time of menopause for healthy women, according to the position statement, especially for those who have menopause symptoms.
When measured while on treatment, bone mineral density correlates with the patient’s current risk for fracture. This justifies use of the T-score at the hip as an appropriate clinical target guiding choices of therapy, according to NAMS.
And while anti-remodeling drugs such as bisphosphonates and denosumab are used to treat most osteoporosis patients, the position statement recommends women at very high risk for fracture follow a new paradigm of beginning treatment with a bone-building agent followed by an anti-remodeling agent.
“This new position statement on osteoporosis provides clinicians with a practical guide to assessing and managing bone health in postmenopausal women and emphasizes an individualized approach with regular follow-up and adjustment based on changing clinical needs and patient preference,” NAMS medical director Stephanie S. Faubion, MD, MBA, FACP, NCMP, IF, said in the release.