Dr Susannah O’Sullivan FRACP, PhD
Endocrinologist, Greenlane Clinical Centre, Auckland, New Zealand
Osteoporosis and fracture can be a major health problem for women in later post-menopausal life. Younger post-menopausal women are generally considered to be at low risk of developing these conditions, however bone loss may begin in the menopause transition (peri-menopause) and predispose women to development of osteoporosis and fracture later in life. Studies have shown that the peri-menopause and early post-menopause are characterised by rapid bone loss and changes in bone micro-architecture, both of which may contribute to increased bone fragility. In women at risk of developing osteoporosis, prevention of loss of bone density and skeletal integrity may reduce the chances of developing this condition, and the associated increased risk of fracture. In addition to conventional risk factors for osteoporosis, the presence of low peak bone mass, and early and rapid menopausal bone loss, might aid in identifying candidates for treatment in the peri-menopause or early post-menopause. Menopausal hormone therapy (MHT) offers a treatment option that increases bone density and prevents fractures, and could be employed as part of a long-term osteoporosis management strategy. In those for whom MHT is not an option, an alternative strategy that has been studied in older post-menopausal women is the use of periodic administration of intravenous bisphosphonate. In those at high risk of fracture, potent anti-resorptive or anabolic treatments should be considered.