Sequential management of postmenopausal health and osteoporosis : An update
Calaf Alsina, Joaquim (Institut d'Investigació Biomèdica Sant Pau)
Cano, Antonio (Universitat de València)
Guañabens, Núria (Hospital Clínic i Provincial de Barcelona)
Palacios, Santiago (Institute Palacios of Woman's Health)
Cancelo, M. Jesús (Hospital Universitario de Guadalajara)
Castelo-Branco, Camil (Hospital Clínic i Provincial de Barcelona)
Larrainzar-Garijo, Ricardo (Hospital Universitario Infanta Leonor)
Neyro, José Luis (Hospital Universitario de Cruces (Barakaldo, País Basc))
Nogués Solán, Xavier (Institut Hospital del Mar d'Investigacions Mèdiques)
Díez Pérez, Adolfo (Institut Hospital del Mar d'Investigacions Mèdiques)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Increased life expectancy means that women are now in a hypoestrogenic state for approximately one-third of their lives. Overall health and specifically bone health during this period evolves in accordance with aging and successive exposure to various risk factors. In this review, we provide a summary of the approaches to the sequential management of osteoporosis within an integrative model of care to offer physicians a useful tool to facilitate therapeutic decision-making. Current evidence suggests that pharmacologic agents should be selected based on the risk of fractures, which does not always correlate with age. Due to their effect on bone turnover and on other hormone-regulated phenomena, such as hot flushes or breast cancer risk, we position hormone therapy and selective estrogen receptor modulators as an early postmenopause intervention for the management of postmenopausal osteoporosis. When the use of these agents is not possible, compelling evidence supports antiresorptive agents as first-line treatment of postmenopausal osteoporosis in many clinical scenarios, with digestive conditions, kidney function, readiness for compliance, or patient preferences playing a role in choosing between bisphosphonates or denosumab during this period. For patients at high risk of osteoporotic fracture, the "anabolic first" approach reduces that risk. The effect on bone health with these bone-forming agents or with denosumab should be consolidated with the subsequent use of antiresorptive agents. Regardless of the strategy, follow-up and treatment should be maintained indefinitely to help prevent fractures.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	Integrative care ; Osteoporosis ; Postmenopausal health ; Sequential management
Publicat a:	Maturitas, Vol. 177 (november 2023) , p. 107846, ISSN 1873-4111

DOI: 10.1016/j.maturitas.2023.107846
PMID: 37738717

10 p, 2.0 MB

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