Osteoporosis, a “silent disease,” is often unrecognized until fracture. Lifestyle modification with nutritional counseling is recommended during menopausal transition. Bone density testing is recommended for women aged 65 years and older, younger postmenopausal women with risk factors, or to follow therapy. Bisphosphonates treat osteoporosis (prevent bone resorption). Raloxifene and hormone therapy prevent bone loss and fracture, with extraskeletal benefits. Denosumab treats osteoporosis, although bone effects reverse rapidly. Teriparatide (anabolic therapy) is considered for women at high risk of fracture. Bazedoxifene with conjugated estrogens, novel delivery of teriparatide, new parathyroid hormone proteins, anti-sclerostin antibodies, cathepsin K inhibitors, and stem cell therapies are in testing.
*Department of Obstetrics & Gynecology, Division of Midlife Health Center
†Department of Medicine, Division of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville, Virginia
In the past 36 months, J.V.P. served (fees to University of Virginia) as a consultant for Pfizer Inc., Noven Pharmaceuticals, DepoMed, and Shionogi and received grants/research support from DepoMed, Bionova, and Endoceutics with travel funds from Pfizer Inc., Noven Pharmaceuticals, Shionogi, and DepoMed. The remaining authors declare that they have nothing to disclose.
Correspondence: JoAnn V. Pinkerton, MD, Department of Obstetrics & Gynecology, Division of Midlife Health Center, University of Virginia, Charlottesville, VA. E-mail: firstname.lastname@example.org