The British Menopause Society Council aims to aid health professionals to inform and advise women about post reproductive health. Osteoporosis affects 1 in 3 women. This guidance regarding oestrogen and non oestrogen based treatments for osteoporosis responds to the controversies about the benefits and risks of individual agents. Treatment choice should be based on up to date evidence based information and targeted to individual women’s needs.
Summary practice points
- HRT reduces the risk of both spine and hip as well as other osteoporotic fractures.
- Oestrogen remains the treatment of choice for osteoporosis prevention in menopausal women, and especially in those with premature ovarian insufficiency.
- Bisphosphonates are effective for treatment of established osteoporosis, reducing both spine and hip fractures.
- Bisphosphonates have a very long skeletal retention time and hence should be used with caution in younger postmenopausal women (e.g. those aged below 65 years).
- Denosumab is an effective treatment for reducing spine and hip fractures in osteoporotic women.
- Denosumab should be avoided in women with increased susceptibility to infections.
- There may be an increased risk of fractures after denosumab discontinuation.
- Provision of adequate dietary or supplemental calcium and vitamin D is a part of osteoporosis management
- The effects of calcium and vitamin D supplements alone on fracture reduction however, are contradictory and may depend on the study population