Based on the clinical guidelines of the American
Association of Clinical Endocrinologists (AACE),
evaluation for postmenopausal osteoporosis should
include (1) a comprehensive medical examination
(including measurement of height); (2) assessment
of risk factors for fractures; (3) BMD measurements
in younger postmenopausal women who have risk
factors, and in all women 65 years and older;
and (4) assessment of the patient's reliability,
understanding, and willingness to accept available
interventions. If one or more risk factors are
present, BMD testing may be indicated to determine
whether therapy is appropriate. It is important
to evaluate BMD in all postmenopausal women
who present with fractures, and to provide counseling
about diet, exercise, and pharmacologic treatment.
While primary osteoporosis is bone loss that
occurs during the normal aging process, secondary
osteoporosis results from a specific clinical
disorder, and should be considered in a patient
who presents with a fracture not resulting from
major trauma or with a reduction in BMD.
Postmenopausal women should receive education
on the impact of many lifestyle choices on bone
health. In addition to the negative impact of
cigarette smoking, excessive alcohol consumption
and physical inactivity, patients may not be
aware of the long-term health consequences of
inadequate calcium and vitamin D intake-particularly
its impact on reducing bone mass and the risk
that age-related and postmenopausal bone loss.
Following a diagnosis of osteoporosis, the goal
of treatment is to prevent further bone loss,
to reduce the risk of an osteoporotic fracture,
and to prevent recurrent fractures in women
who have already experienced an osteoporosis-related
fracture (even if it is an asymptomatic vertebral
deformity). Clinical guidelines are available
to help guide treatment options. Two primary
types of FDA-approved drug treatments for osteoporosis
are available: antiresorptive agents (e.g.,
alendronate, risedronate, raloxifene, calcitonin)
and anabolic agents (e.g., teriparatide). |
