Abstract
Introduction: The important target when managing females with post-menopausal osteoporosis is to avoid the development of future pathological fractures. Thus, detecting females at the highest risk is a priority. Low bone mineral density, especially at the site of the hip, is an important risk factor for the development of pathological fractures: for every 1-SD decrement in bone mineral density, the risk of developing a pathological fracture increases by a factor of two to three, 6 therefore, most protocols suggest a single bone mineral density evaluation at or around sixty-five years of age. On the other hand, a more comprehensive evaluation of clinical predisposing factors is beneficial to help define the absolute risk for an individual and to detect patients who require management. The Fracture Risk Assessment Tool (FRAX), that was created by the WHO based on data acquired from several international cohort studies, incorporates established risk factors and bone mineral density at the site of the femoral neck to predict individual ten-year risk of developing a hip or another major osteoporotic fracture; in addition, its main use is encouraged by multiple international professional organizations.
Aim of work: In this review, we will discuss osteoporosis.
Methodology: We did a systematic search for osteoporosis using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.
Conclusions: Females who have a low bone mineral density and a history of pathological fractures are consistent with having osteoporosis. It is recommended for these females to increase physical exercise, avoid smoking and alcohol abuse, and consume a total calcium intake of 1000 to 1500 milli-gram daily and a total vitamin D intake of 600 to 800 IU daily, along with the administration of an anti-resorptive medication. It is also generally recommended to prescribe a bisphosphonate as a first-line treatment if there are no clear contraindications; with a thorough discussion with the patient about the rare possible risks of developing atypical femur fracture or jaw osteonecrosis but also the higher anticipated effects in terms of overall decrease in the rates of developing pathological fractures. Based on the results of follow-up bone mineral density measurement, it is also recommended to discuss the possibility of temporarily stopping the bisphosphonate after five years of treatment.