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Therapy for Osteoporosis

Prevention and management of osteoporosis in women begins with lifestyle approaches, such as eating a balanced diet, adequate calcium and vitamin D, appropriate exercise, avoiding cigarette smoke and excessive alcohol consumption, and preventing falls. For postmenopausal women at low risk of osteoporotic fracture, lifestyle approaches may be all that is needed.

Osteoporosis is common among older postmenopausal women. Although the prevalence is only 4% in women aged 50 to 59 years, the prevalence rises with age to 52% in women aged 80 years and older. Thus, as women age, pharmacologic management is more frequently indicated. Of note, if two women of different ages have the same bone density, the older one is more likely to sustain a fracture than the younger one.

NAMS recommends adding osteoporosis drug therapy in the following populations:

  • All postmenopausal women who have had an osteoporotic vertebral or hip fracture
  • All postmenopausal women who have BMD values consistent with osteoporosis (ie, T-scores equal to or worse than -2.5) at the lumbar spine, femoral neck, or total hip region
  • All postmenopausal women who have T-scores from -1.0 to -2.5 and a 10-year risk, based on the FRAX calculator, of major osteoporotic fracture (spine, hip, shoulder, or wrist) of at least 20% or of hip fracture of at least 3%

Healthcare providers should refer to the NAMS Position Statement on the management of osteoporosis in postmenopausal women for more thorough risk assessment and management guidance. Because of the number and variety of prescription therapies for osteoporosis available in the United States and Canada, NAMS has prepared a table listing them, with their indications and dosages, as an adjunct to the Position Statement.

Providers should check the full prescribing information for any updates and for information that is not provided here, such as warnings and contraindications.


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