Postmenopausal osteoporosis – An Indian perspective

Abstract

Osteoporosis is the most common metabolic bone disease in humans. It is more common in women and contributes to significant morbidity and mortality. Postmenopausal osteoporosis is due to the withdrawal of the protective effect of estrogen at menopause and increased follicle-stimulating hormone, all contributing to increased bone resorption. Evaluation of osteoporosis involves assessment of risk factors, biochemical evaluation, assessment of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA), identification of vertebral fractures with vertebral fracture assessment tool, and prediction of fracture risk with various tools. Treatment includes prevention of osteoporosis using lifestyle modification and fall prevention, in addition to pharmacotherapy. Several drugs are licensed to reduce fracture risk namely anti-resorptive agents (such as bisphosphonates and denosumab) and anabolic agents (such as teriparatide). Improved understanding of the cellular basis for osteoporosis has resulted in new drugs targeted to key pathways in the pathogenesis. The response to treatment is monitored using bone turnover markers as well as DXA scan.