Despite there is not drugs capable to reduce the risk of fractures of 50%-70% after 6-12 months of treatment, postmenopausal osteoporosis often remains not recognized and consequently not treated, with easily foreseeable consequences. The North American Menopause Society (NAMS), in its declarations in 2010, affirms that all women in post-menopause should be assessed for risk factors associated with osteoporosis, to recognize fracture risk factors, to eliminate possible causes for secondary osteoporosis, to modify risk factors and to choose candidates for pharmacological therapy.In order to better assess fracture risk, now we have the FRAX algorithm at our disposition, while NAMS recommends pharmacological treatment for all patients with clinical (vertebral of hip fractures) or densitometric (T score < -2.5) diagnosis of osteoporosis. Pharmacological therapy is also recommended for those women with a T score between -2.5 and 1.0, but presenting a fracture risk at 10 years higher than 20%, calculated through the FRAX algorithm. In the therapeutical field, denosumab, a human monoclonal antibody inhibiting osteoclast genesis, is added to the series of bisphosphonates. In a wide trial, this drug has reduced the risk of vertebral and hip fractures, through two yearly subcutaneous injections, so it becomes the first-choice drug in patients with a reduced renal function or not tolerating bisphosphonates. As to this last therapy, much is discussed on the need to interrupt it after 3 years: when patients with osteoporosis interrupt the assumption of risedronate after 3 years, in spite of the fact that a drop in bone mineral density and an increase in the markers of bone turnover occur, vertebral fractures occur with an incidence cut by half compared to women using placebo. In women treated with alendronate for 5 years, the following fractures occur with a similar frequency, independently from the continuation or discontinuation of bisphosphonate assumption, even if women treated for 10 years present less fracture risk factors then the ones treated for 5 years.
Diagnostic and therapeutical strategies of osteoporosis have by now been improved and enriched with new and effective drugs. Osteoporosis remains a severe problem in menopausal women (and not only in them), so it is necessary to diagnose and treat it in time, since its worst consequences (fractures) continue to have the very first places in the scale of diseases in old age.
