Postmenopausal osteoporosis
Also known as:
Bone loss after menopause, low bone density
Estrogen loss speeds bone breakdown. Screening, strength training and modern medicines prevent fractures.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
What it is
Bone is constantly remodeled. Estrogen restrains the cells that break bone down, so when it falls, bone loss accelerates, fastest in the years around the final period. Osteoporosis means bones have become thin and fragile enough to break with minor falls.
Symptoms
Usually none until a fracture. Clues include height loss, a forward-curving upper back or a fracture from a fall from standing height.
How it's diagnosed
A DXA scan gives a T-score; -2.5 or lower at the spine or hip means osteoporosis. A fragility fracture of the hip or spine is diagnostic on its own. FRAX estimates 10-year fracture risk. The USPSTF recommends screening women 65 and older and younger postmenopausal women at increased risk.
Treatment
Foundations are enough calcium and vitamin D, progressive resistance and impact training, and fall prevention. First-line medicines are bisphosphonates (alendronate, risedronate, zoledronic acid). Denosumab is effective but must not be stopped abruptly without a follow-on plan, because of rebound vertebral fractures. For very high risk, anabolic agents (teriparatide, abaloparatide, romosozumab) build new bone. Menopausal hormone therapy also prevents fractures and suits younger women with symptoms.
Clinical pearls
• In the LIFTMOR trial, supervised high-intensity resistance and impact training improved bone density in postmenopausal women with low bone mass.
• Recheck DXA on the same machine where possible.
Key studies and references
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Category
Menopause & bone
Also known as
Bone loss after menopause, low bone density
Reviewed by
Farhan Tahir, MD
Questions about your own care?
Dr. Tahir’s team offers consults through Youthful Medicine.
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