Update over de diagnose en behandeling van postmenopauzale osteoporose

Update on the diagnosis and treatment of postmenopausal osteoporosis Osteoporosis is characterized by a low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in spontaneous or low-impact fractures. These fractures are associated with a significant impact on morbidity and mortality. This article provides a literature overview of the most recent guidelines of the Belgian Bone Club with regard to screening, diagnosis, treatment and follow-up of postmenopausal osteoporosis. The Belgian Bone Club recommends screening for osteoporosis in all women ≥ 50 years, or at the age of menopause if this occurs earlier. After a positive screening, the guidelines recommend an evaluation of previous fragility fractures, a measurement of bone mass by DXA and a calculation of the fracture risk with computer-based algorithms. Based on these three criteria, we categorize the fracture risk as low, high or very high. Lifestyle measures and sufficient calcium and vitamin D intake are recommended in all categories. Antiresorptive treatment should be considered for high-risk patients (selective estrogen receptor modulators, bisphosphonates or the anti-RANK antibody denosumab). For patients at very high-risk, anabolic therapy, such as teriparatide or romosozumab, is preferred. All anabolic therapy should be followed by antiresorptive therapy. It is recommended to regularly monitor the effectiveness and tolerance of therapy, including a DXA measurement every 2 to 5 years.