Managing Perimenopausal Bone Loss: The Role of Bisphosphonate Treatment.

Preventing the rapid loss of bone density and structure that occurs during the perimenopause is a unique opportunity to prevent the development of postmenopausal osteoporosis and high fracture risk. For women who are not candidates for estrogen therapy, low-dose bisphosphonate therapy for 3 to 5 years can prevent perimenopausal bone loss, after which intermittent bisphosphonate therapy can maintain skeletal health indefinitely. Identifying women at high risk for developing osteoporosis with bone density testing as they approach or enter perimenopause and considering prevention therapy should be a routine part of the clinical management of midlife women.