Menopausal and bone risk assessments in postmenopausal women

The National Osteoporosis Foundation expects an increased prevalence of low bone mass and osteoporosis to 61 million cases by 2020. Nearly 50% of C aucasian postmenopausal women have osteopenia or osteoporosis, with a lifetime risk of an osteoporotic fracture of 40%. As bone loss is clinically silent until a fracture occurs, identifying risk factors and measuring bone density are currently the best available methods for determining a woman’s probability of developing osteoporosis. A careful history and physical should assess for potential secondary causes of low bone density and help to guide further evaluations and treatments. Hormonal therapy, best when initiated within the first few years of perimenopause, can decrease the risk of osteoporotic fractures by approx 50% while treating common menopausal symptoms. Recent studies questioning the risks of hormonal therapy mandate an individualized assessment of the potential risk-benefit ratio.