Proactive Intervention and Multidimensional Collaboration: Prevention and Comprehensive Management of Osteoporosis in Perimenopausal and Postmenopausal Women

The clinical burden of osteoporosis in perimenopausal and postmenopausal women is becoming increasingly prominent. The disease has a well-defined onset stage: perimenopause is a critical window for accelerated bone loss, while the five to ten years after menopause are a peak period for fractures. Epidemiological surveys show that the prevalence in Chinese women over 50 years old is nearly half, and the disease continues to rise with age. Its core mechanism is enhanced bone resorption and insufficient bone formation caused by a sudden drop in estrogen levels. Combined with calcium and vitamin D deficiency and genetic susceptibility, this ultimately leads to a sharp increase in the risk of vertebral and hip fractures. Clinical treatment primarily involves drugs such as bisphosphonates and denosumab, which can reduce fracture incidence, but poor adherence to treatment and long-term adverse effects limit their widespread use. Lifestyle interventions such as resistance training and calcium and vitamin D supplementation, while effective adjunctively, are rarely effective alone in high-risk populations. Emerging therapies, such as drugs targeting the RANKL pathway and stem cell therapy, are being explored, but the evidence remains insufficient to support routine use. This review aims to clarify the epidemiology, molecular mechanisms, and progress in prevention and treatment of this disease, and to propose possible approaches for individualized and multidisciplinary management in the future.