Bone loss or lost bone: Rationale and recommendations for the diagnosis and treatment of early postmenopausal bone loss
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- Zaidi, M., Turner, C.H., Canalis, E. et al. Curr Osteoporos Rep (2009) 7: 118. doi:10.1007/s11914-009-0021-4
Recent reports suggest that bone loss begins during late perimenopause at a dramatic rate, even before estrogen levels plummet. During the ensuing 5 years, there is evidence of the beginnings of microarchitectural deterioration, which impacts bone strength and ultimately enhances its propensity to fracture. The diagnosis of osteoporosis based on T-scores alone, or through stratification for a high fracture risk by FRAX, excludes these women who are rapidly losing bone. Because all antiosteoporosis therapies, in particular bisphosphonates, reduce bone loss, we propose aggressive, likely short-term therapy with a goal to reduce bone loss, stabilize bone density, and prevent microarchitectural deterioration.