The North American Menopause Society has updated its 2010 position statement on postmenopausal osteoporosis, which was released last week. The statement is published in the journal Menopause, the journal of the North American Menopause Society (NAMS).¹ Some key recommendations from the statement are:

• To reduce the risk of bone loss and osteoporotic fractures, lifestyle changes should be adopted such as maintaining a healthy weight, eating a balanced diet, obtaining adequate calcium and vitamin D, participating in regular physical activity, avoiding excessive alcohol consumption, not smoking, and using measures to prevent falls.
• All postmenopausal women should be evaluated annually with height and weight, assessment for chronic back pain, kyphosis and clinical risk factors for osteoporosis, fractures, and falls.
• Assess bone mineral density (BMD) in all women aged ≥65 years, history of fracture after attaining menopause (excluding skull, facial bone, ankle, finger and toe fractures), women on steroids for more than 3 months.
• Test BMD in postmenopausal women <65 years of age in the presence of risk factors such as current smoker, excessive alcohol consumption, women on long-term medication (steroid, aromatase inhibitor), history of hip fracture in a parent, body weight <57.7 kg (or BMI < 21kg/m2) or women who had taken estrogen and discontinued it.
• DXA is the preferred method to test BMD.
• In women aged ≥70 years or those with previous history of height loss of > 1.5 inches, vertebral imaging can be used.
• Daily intake of calcium (1000-1,200 mg) and vitamin D3 (400-800 IU) in women aged ≥50 years. They are not routinely recommended, only when dietary sources are inadequate.
• Prescribe pharmacotherapy to prevent bone loss in women with premature menopause, low BMD ((T-score <-1.0), family history of fractures, acute estrogen deficiency in menopausal transition, discontinuing estrogen therapy.
• All postmenopausal women with history of vertebral or hip fracture should be treated for osteoporosis as also those women with T-scores < 2.5 at the lumbar spine, neck of femur or total hip. Women with T-scores ranging from 1.0 to 2.5 + presence of risk factors such as history of multiple fractures (except face, feet and hands), history of fracture of proximal humerus, pelvis, or distal forearm should also be treated for osteoporosis.
• Before starting treatment, a comprehensive evaluation must be done, including for secondary cause of osteoporosis.
• Along with drug therapy for osteoporosis, calcium (1000-1,200 mg) and vitamin D3 (400-800 IU) must be ensured as adjunct treatment.
• In older women with history of recent fractures, T-scores ≤3.0 or multiple risk factors, osteoanabolic therapies such as teriparatide may be considered.
• Regularly evaluate the patient and re-assess the prescribed medications.

Reference

1. The North American Menopause Society (NAMS). Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021 Sep 1;28(9):973-997. doi: 10.1097/GME.0000000000001831.