Abstract

RECENT DEVELOPMENTS IN THE PATHOPHYSIOLOGY, DIAGNOSIS AND MANAGEMENT OF POSTMENOPAUSAL OSTEOPOROSIS: AN EXTENSIVE REVIEW

Aditi B. Saswade*, Chandrashekhar D. Patil, Jubershaha S. Fakir, Sunil K. Mahajan

ABSTRACT

Postmenopausal osteoporosis is a serious public health problem and is one of the most common metabolic bone diseases in women. The condition is associated with low bone mineral density, bone micro-architecture deterioration and fracture risk. Estrogen deficiency after menopause is a key component in disease pathogenesis, creating a bone loss ratio of increased osteoclastic activity to decreased bone formation. Osteoporotic fractures, especially the hip, vertebral and wrist fractures, are a unique source of morbidity, mortality, disability, reduced quality of life and health care costs. Early diagnosis and risk assessment, is crucial for effective disease management. Dual-energy X-ray absorptiometry (DXA) is the standard method for measuring bone mineral density and fracture risk assessment tools like FRAX are valuable aids in the identification of those at high risk for fracture. Therapies used today encompass antiresorptive agents (bisphosphonates and denosumab) and anabolic agents (teriparatide, abaloparatide, and romosozumab). Comprehensive management includes providing sufficient calcium and vitamin D, regular weight-bearing exercise, healthy lifestyle changes, and fall prevention programs, as well as medications. The field of osteoporosis has been greatly advanced in recent years, with personalized medicine, sequential anabolic–antiresorptive therapy, Artificial Intelligence (AI) assisted fracture prediction, new molecular targets, gene-based interventions and nanotechnology-based drug delivery systems all providing new avenues for treatment. This review aims to offer a comprehensive overview of the epidemiology, pathophysiology, risk factors, diagnosis and current management of postmenopausal osteoporosis, with a specific focus on novel therapeutic advances and future directions in clinical practice.

Keywords: Postmenopausal osteoporosis; Bone mineral density; Estrogen deficiency; Fragility fractures; DXA.