Postmenopausal Osteoporosis

Management of postmenopausal osteoporosis includes nonpharmacologic treatment (e.g., weightbearing exercise and fall-prevention strategies) and pharmacologic treatment. Bisphosphonates are considered first-line treatment in most women; benefits and rare potential risks are discussed. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage A 73-year-old asymptomatic white woman with a history of a Colles fracture of the left radius 10 years earlier presents for evaluation. Dual-energy x-ray absorptiometry reveals a bone mineral density (BMD) T score of −2.8 in the lumbar spine and −2.5 in the total hip. How should this case be managed? The Clinical Problem Osteoporosis results in 1.5 million fractures per year in the United States, with the vast majority occurring in postmenopausal women. The disease is characterized by skeletal fragility and microarchitectural deterioration. The conceptual definition of osteoporosis links the high risk of postmenopausal fractures to low BMD . . .