Department of Translational Medicine, Menopause and Osteoporosis Center, University of Ferrara, Ferrara, Italy -
University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy -
Minerva Obstet Gynecol. 2021 Dec;73(6):714-729. doi: 10.23736/S2724-606X.21.04896-X.
Postmenopausal osteoporosis is a chronic progressive condition characterized by reduced bone mass and impaired bone quality, leading to an increased risk of fragility fractures. Osteoporotic fractures reduce quality of life and are associated with high morbidity, mortality and economic burden. Primary and secondary prevention interventions are always recommended starting from the premenopausal age, in women after menopause, however, it is essential to develop a long-term intervention strategy that allows to identify patients at high risk of fracture and the choice of therapy based on the estimated risk. This narrative review described the tools for layering the management approach in relation to low, high and very high fracture risk. Several medications are now available for the treatment of osteoporosis and the prevention of fractures; the knowledge of the efficacy, safety and additional benefits profile of the individual preparations allows an appropriate choice between the different drugs available and the possibility of adapting the prescription to the lifetime fracture risk spectrum. From the literature it emerges that menopausal hormone therapy (MHT), TSEC combination and SERMs can be drugs of choice to counteract postmenopausal bone loss in younger women or at low risk of fracture, while bisphosphonates and denosumab are appropriate for women with high risk or at an older age. Therapy with denosumab and anabolic agents such as teriparatide and romosozumab is particularly indicated for subjects with very high risk of fracture.
绝经后骨质疏松症是一种慢性进行性疾病，其特征是骨量减少和骨质量受损，导致脆性骨折的风险增加。骨质疏松性骨折降低了生活质量，并与高发病率、死亡率和经济负担相关。一级和二级预防干预措施始终建议从绝经前年龄开始，对于绝经后的女性，然而，制定一种长期干预策略是至关重要的，该策略可以识别出骨折高风险患者，并根据估计的风险选择治疗方法。本叙述性综述描述了与低、高和极高骨折风险相关的分层管理方法的工具。现在有几种药物可用于治疗骨质疏松症和预防骨折；了解个体制剂的疗效、安全性和额外益处概况，可以在可用的不同药物之间进行适当选择，并有可能根据终生骨折风险谱调整处方。文献表明，绝经激素治疗（MHT）、TSEC 联合和 SERMs 可以作为治疗年轻女性或低骨折风险患者绝经后骨丢失的首选药物，而双膦酸盐和地舒单抗适用于高风险或年龄较大的女性。地舒单抗和特立帕肽、罗莫佐单抗等合成代谢药物等药物的治疗特别适用于骨折风险极高的患者。
