Prevention Early After Menopause

Summary

• Early intervention is clearly an important strategy for the prevention of postmenopausal osteoporosis.

• Prevention of osteoporosis with HRT can still be considered a first-line strategy, but risks and benefits need to be assessed in each individual case. Such treatment leads to improved longevity and quality of life. It also relieves menopausal symptoms and decreases the incidence of other menopause-related conditions affecting the urogenital and central nervous systems. It may, however, have some undesirable adverse effects.

• An alternative for estrogens to prevent osteoporosis is raloxifine. Other anti-resorptive drugs, such as bisphosphonates, play an important role in preventing osteoporosis and bone fractures. Calcitonin has only a limited place in therapy.

• The roles of calcium intake and physical activity are secondary in the prevention of osteoporosis during the early postmenopause. rhPTH may be a promising agent for the future, but it is more likely to be used for the treatment than the prevention of osteoporosis.

The development of osteoporosis depends on both the peak bone mass attained and its subsequent loss. Peak bone mass is achieved in early adulthood and is determined largely genetically. To a lesser extent, bone mass is dependent on diet, exercise, alcohol consumption, smoking, drugs (e.g, corticosteroids, contraceptive pills), parity, and the presence or absence of ovarian function.

The development of osteoporosis results from an imbalance between bone resorption and bone formation. The loss of gonadal function and aging are the two most important factors. Starting around the fourth or fifth decade of life, men and women lose 0.3–0.5% of bone a year. After the loss of gonadal function, this is increased by up to tenfold in women due to an increase in bone turnover.