Early postmenopausal bone loss and what to do about it.

The pattern of lifelong changes in bone mass in women characterized in several publications generally shows that peak adult bone mass is achieved at about the end of adolescence or later, and begins to decline as menopause approaches. Uncertainties remain regarding the exact age at which peak bone mass is reached and when it starts to decline. The data indicate that the onset of rapid bone loss in healthy women begins at about two years before the last menses and is complete at about four to five years after the last menses. The bone loss at the spine, total body, and femoral neck over these years is equal to about one T-score and is largely irreversible after it occurs. This presentation examines the data on these questions and focuses on the perimenopausal pattern of rapid bone loss and the implications for identifying and managing the later-life risk of fracture.