Menopause. 2006 May-Jun;13(3):340-67; quiz 368-9. doi: 10.1097/01.gme.0000222475.93345.b3.
To update the evidence-based position statement published by The North American Menopause Society (NAMS) in 2002 regarding the management of osteoporosis in postmenopausal women.
NAMS followed the general principles established for evidence-based guidelines to create this updated document. A panel of clinicians and researchers expert in the field of metabolic bone diseases and/or women's health were enlisted to review the 2002 NAMS position statement, compile supporting statements, and reach consensus on recommendations. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees.
Osteoporosis, whose prevalence is especially high among elderly postmenopausal women, increases the risk of fractures. Hip and spine fractures are associated with particularly high morbidity and mortality in this population. Given the health implications of osteoporotic fractures, the primary goal of osteoporosis therapy is to prevent fractures, which is accomplished by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors that may contribute to fractures. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. The most common risk factors for osteoporotic fracture are advanced age, low bone mineral density, and previous fracture as an adult. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. If pharmacologic therapy is indicated, government-approved options are bisphosphonates, a selective estrogen-receptor modulator, parathyroid hormone, estrogens, and calcitonin.
Management strategies for postmenopausal women involve identifying those at risk of low bone density and fracture, followed by instituting measures that focus on reducing modifiable risk factors through lifestyle changes and, if indicated, pharmacologic therapy.
更新北美更年期协会（NAMS）于2002年发布的关于绝经后女性骨质疏松症管理的循证立场声明。
NAMS遵循循证指南制定的一般原则来创建这份更新文件。招募了一组代谢性骨病和/或女性健康领域的临床医生和研究人员专家，以审查2002年NAMS立场声明、汇编支持性声明并就建议达成共识。该小组的建议经NAMS董事会审查并批准。
骨质疏松症在老年绝经后女性中患病率尤其高，会增加骨折风险。髋部和脊柱骨折在该人群中与特别高的发病率和死亡率相关。鉴于骨质疏松性骨折对健康的影响，骨质疏松症治疗的主要目标是预防骨折，这通过减缓或停止骨质流失、维持骨强度以及最小化或消除可能导致骨折的因素来实现。对绝经后女性进行骨质疏松症风险评估需要病史、体格检查和诊断测试。绝经后骨质疏松症的主要风险因素（根据骨密度定义）包括高龄、遗传、生活方式因素（如钙和维生素D摄入量低、吸烟）、消瘦和绝经状态。骨质疏松性骨折最常见的风险因素是高龄、低骨密度和既往成年后骨折。管理首先侧重于非药物措施，如均衡饮食、充足的钙和维生素D摄入、适当运动、戒烟、避免过量饮酒以及预防跌倒。如果需要药物治疗，政府批准的选择有双膦酸盐、选择性雌激素受体调节剂、甲状旁腺激素、雌激素和降钙素。
绝经后女性的管理策略包括识别那些有低骨密度和骨折风险的人，随后采取措施，通过生活方式改变来减少可改变的风险因素，如果需要，进行药物治疗。
