NAMS Management of Osteoporosis in Postmenopausal Women: 2021 Position Statement Guideline Summary

Key Points

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