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Feature Article

Postmenopausal osteoporosis: identifying women at risk and selecting appropriate agents

Terry Diamond, Terry Golombik
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Postmenopausal osteoporosis is now occurring in epidemic proportions. GPs have the responsibility of identifying women at high risk of osteofragility fractures.

Key Points

  • The prevalence of osteofragility fractures in postmenopausal women is rapidly escalating. These fractures lead to an increase in morbidity and premature mortality.
  • The fracture risk in postmenopausal women should be calculated according to both osteoporotic risk factors and bone mineral density (BMD) T-scores.
  • Secondary causes of osteoporosis should always be excluded prior to initiating antiosteoporotic therapies.
  • Specific pharmacological agents are rebatable on the PBS for postmenopausal women aged 70 years or over with a BMD T-score of -3.0 or less (primary prevention) and postmenopausal women with a BMD T-score of -2.5 or less and a prior osteofragility fracture (secondary prevention).
  • Anticatabolic therapies are considered first-line agents for women with osteofragility fractures.
  • Anabolic agents should be considered in women who continue to have fractures despite optimal anticatabolic therapies.
  • Simpler dosing regimens, improved drug tolerability and patient compliance programs encourage women to continue therapies for longer periods of time, thereby enhancing therapeutic outcomes.