Sequential management of postmenopausal health and osteoporosis: An update.

Increased life expectancy means that women are now in a hypoestrogenic state for approximately one-third of their lives. Overall health and specifically bone health during this period evolves in accordance with aging and successive exposure to various risk factors. In this review, we provide a summary of the approaches to the sequential management of osteoporosis within an integrative model of care to offer physicians a useful tool to facilitate therapeutic decision-making. Current evidence suggests that pharmacologic agents should be selected based on the risk of fractures, which does not always correlate with age. Due to their effect on bone turnover and on other hormone-regulated phenomena, such as hot flushes or breast cancer risk, we position hormone therapy and selective estrogen receptor modulators as an early postmenopause intervention for the management of postmenopausal osteoporosis. When the use of these agents is not possible, compelling evidence supports antiresorptive agents as first-line treatment of postmenopausal osteoporosis in many clinical scenarios, with digestive conditions, kidney function, readiness for compliance, or patient preferences playing a role in choosing between bisphosphonates or denosumab during this period. For patients at high risk of osteoporotic fracture, the "anabolic first" approach reduces that risk. The effect on bone health with these bone-forming agents or with denosumab should be consolidated with the subsequent use of antiresorptive agents. Regardless of the strategy, follow-up and treatment should be maintained indefinitely to help prevent fractures.
Competing Interests: Declaration of competing interest JC-A has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bayer, Gedeon Richter, Organon, and Theramex; payment for expert testimony from Gedeon Richter; support for attending meetings and/or travel from Theramex; and has participated on a Data Safety Monitoring Board or Advisory Board with Organon. AC has been advisory board member for Astellas, Viatris, Theramex; has received speaker honorarium from Astellas, Viatris, Theramex, Abbott; and has received consulting honorarium from Astellas, Viatris, Theramex. NG, has been advisory board member for Amgen, UCB; has received speaker honorarium from Amgen, UCB, Lilly, Gedeon-Richter, Theramex; and has received travel grants from Lilly, UCB. SP has been advisory board member for Theramex; has received grants or contracts from Bayer, Gedeon Richter, Procare Lacer; has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Servier, Procare, Theramex, Shionogi, Procaps, Exeltis, UCB, NovoNordisk; has received support for attending meetings and/or travel from Shionogi, NovoNordisk; has participated in a Data Safety Monitoring Board or Advisory Board for Theramex, Shionogi, Procare, NovoNordisk. MJC, has received speaker honorarium from Theramex, Shionogui. CC-B has been advisory board member for Theramex; has received research grants to institution from MCIN, European Union (project No. PI21/00461), and Instituto de Salud Carlos III; and has received research grants from Shionogi. XN has received honorarium for lectures and consultancy from Amgen, UCB, STADA, GEDEON, and FAES. RL-G, JLN and AD-P report no competing interest.
(Copyright © 2023. Published by Elsevier B.V.)