Prevention and treatment of osteoporosis in women: an update

Osteoporosis is a growing health problem in the ageing population. A postmenopausal woman has an approximately 50% lifetime risk of suffering an osteoporotic fracture with hip fractures carrying the highest morbidity and mortality. Non-pharmacological prevention strategies focus on attainment and maintenance of a high peak bone mass and include a healthy lifestyle, nutritious and balanced diet, maintenance of optimal vitamin D level and physical exercise with skeletal mechanical loading. Pharmacological interventions include hormone replacement therapy in women with early menopause and postmenopausal women until the age of 60 in the absence of contraindications. Bisphosphonates (e.g. alendronate, risedronate and zoledronate) remain the mainstay of antiresorptive treatment and the novel biologic antiresorptive agent, denosumab is a safe option in patients intolerant or with contraindications to bisphosphonates. Anabolic therapy with PTH peptides is currently reserved for severe osteoporosis. A number of novel treatments e.g. cathepsin K inhibitors, calcilytic drugs anti-sclerostin antibodies are being assessed in clinical trials.