Management of Osteoporosis in Postmenopausal Women: 2021 Position Statement

Publication Date: September 1, 2021
Last Updated: February 21, 2023

Key Points

Overview, Screening and Assessment

  • Osteoporosis is a common disorder with potentially serious consequences.
  • Assessment of skeletal health should be a part of routine care for all postmenopausal women.
  • The annual examination should include measurements of height and weight; assessment for chronic back pain and kyphosis; and clinical risk factors for osteoporosis, fractures, and falls.
  • The most important risk factors for future fracture are a history of previous fracture, older age, and low BMD.
    • Fracture risk is especially high in the first 2 years after an incident fracture.
  • Bone mineral density testing is indicated for all postmenopausal women with risk factors for low BMD or fracture.
    • DXA is the preferred technique for BMD testing.
    • For untreated postmenopausal women at low fracture risk, repeat DXA testing is not useful until at least 5 years have passed, unless rapid bone loss is anticipated.
  • Vertebral imaging is appropriate for postmenopausal women aged 70 years and older or with historical height loss.
  • Secondary causes of osteoporosis should be evaluated before osteoporosis treatment has begun.
  • The routine use of biochemical markers of bone turnover in clinical practice is not recommended.


  • Osteoporosis is a chronic, progressive health issue affecting a large proportion of postmenopausal women.
  • Menopause practitioners should be familiar and comfortable with approaches to the assessment and management of bone health in their patients.
  • Once diagnosed, patients with osteoporosis require lifelong management.
  • Management of bone health in postmenopausal women involves assessment of risk factors for low BMD and fracture, encouraging healthy lifestyle habits to reduce risk factors, and if indicated, pharmacologic therapy.
  • Effective tools for diagnosing osteoporosis and assessing fracture risk are available, and well-studied strategies exist for managing bone health in women at both low and high risk of fracture.
  • By individualizing treatment approaches and monitoring and adjusting those approaches if the clinical picture changes, the consequences of osteoporosis on a menopausal woman’s activity and well-being can be minimized.



Management of Osteoporosis in Postmenopausal Women: 2021 Position Statement

Authoring Organization