Review outlines strategies to prevent menopause-related bone loss

Bone loss accelerates around the final menstrual period, with the review reporting average losses by five years of 10.6% in the lumbar spine and 9.1% at the hip. It identifies low bone mineral density at perimenopause as a key predictor of later osteoporosis. Risk factors include low body weight, prior fracture, family history, prolonged amenorrhea and conditions or medications that adversely affect bone health. The article recommends bone-density testing for perimenopausal women with these risk factors; it notes that FRAX and the Osteoporosis Self-Assessment Tool are not designed to identify this group’s future osteoporosis risk.

The review states that nutrition and physical activity support general health but do not prevent menopause-associated bone loss. Estrogen therapy prevents bone loss while it is used; reported evidence in older postmenopausal women indicates a 30%–40% reduction in spine and hip fractures. The review also discusses raloxifene and bisphosphonates, including use of bisphosphonates after estrogen is stopped because bone benefits dissipate within about 12 months.

This is a clinical review, not a new trial, and its treatment recommendations should be interpreted in light of individual risks and benefits, including breast cancer risk. It notes uncertainty about optimal estrogen dosing and estradiol targets, and that hormone therapy’s skeletal benefits do not persist after discontinuation.