Menopause and Bone Health

Bone health in menopausal women is of prime importance for prevention and management of osteoporosis and to improve quality of life. Osteoporosis-related fractures in the elderly contribute to mortality and significant morbidity. Twenty percent of women with hip fracture die within 1 year and many more have poor quality of life. Menopause transition is a precipitating factor in osteoporosis, particularly in women with low peak bone mass. The advances in diagnosis of bone mineral density using double-energy X-ray absorptiometry (DXA) and assessment of fracture risk using Fracture Risk Assessment Tool (FRAX) have helped in categorising women requiring pharmacological interventions. Calcium, vitamin D, and protein that play a vital role in osteo-sarcopenia and deficiency should be supplemented. Lifestyle modifications including exercises and measures for fall prevention should be emphasised in all elderly postmenopausal women. Menopausal hormone therapy (MHT) is recommended for the prevention of osteoporotic fractures in women with menopausal symptoms. Anti-resorptive medications and osteo-anabolic drugs are recommended for prevention and treatment of postmenopausal osteoporosis. These medications are given generally for 2–3 years followed by drug holiday (except denosumab) and restarted with same or different group of drugs as per risk category. Introduction of denosumab (monoclonal antibody) and romosozumab (anti-sclerostin monoclonal antibody) has improved the care of osteoporosis. Availability of yearly injections (zoledronate) or monthly injections (romosozumab) has impacted acceptability and drug compliance.