Bone metabolism and the perimenopause overview, risk factors, screening, and osteoporosis preventive measures.

In summary, FDA-approved therapies for prevention and treatment of osteoporosis are all antiresorptive agents. There are no approved therapies at this time that stimulate bone formation, although one such agent (PTH) is awaiting approval. Screening perimenopausal women at risk should identify osteopenic women early in the menopause before the accelerated bone loss of estrogen deficiency causes further irreversible erosion in bone density. The National Osteoporosis Foundation advocates initiating therapy to reduce fracture risk in postmenopausal women with T scores below -2 in the absence or factors and with T scores below -1.5 if other risk factors are present. Estrogen, alendronate, residronate, and raloxifene have all been shown to reduce the incidence of radiographic vertebral fractures in women at risk. Only alendronate and residronate have been shown in large randomized trials to reduce the incidence of nonvertebral fractures including hip fractures in women with postmenopausal osteoporosis. These antiresorptive therapies provide benefits above and beyond those of calcium and vitamin D alone. There is insufficient published evidence from randomized controlled trials convincingly to support a role for soy products, androgens, calcitonin, or fluoride in prevention of postmenopausal osteoporosis or reduction of fracture rates in women at risk.