MODERN STRATEGY OF DIAGNOSTICS AND LONG-TERM TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS
Summary. Summary. Present knowledge on approaches to the diagnostics and treatment of postmenopausal osteoporosis is presented and summarized in the review paper. This review attempts to identify medication options and provide the best clinical management strategies for postmenopausal women. The diagnosis of osteoporosis is based on separation of patients with a high fractures risk and identification of the following criteria: suffered osteoporotic fracture, a 10-year fracture probability in the regional FRAX model exceeds the intervention threshold and the T-test determined by the Dual-photon X-ray absorptiometry is below –2.5 SD. Regarding the question on which patients are subject to pharmacological intervention, three groups of patients are distinguished: patients with low-energy fractures in the anamnesis, patients with low bone mass and patients with osteopenic syndrome and a high risk of osteoporotic fractures (according to FRAX). Drug treatment of osteoporosis is aimed at reducing the risk of fractures. Bisphosphonates are first-line drugs. Features of their pharmacology and the ability to accumulate in the bone tissue make it possible to hold pauses in treatment — «drug holidays». The decision on the duration of bisphosphonate therapy and the duration of interruption in treatment, as well as the use of drugs with an alternative mechanism of action, should be made taking into account the individual characteristics of a patient, using an annual assessment of risk factors, dynamics of bone mineral density and bone turnover markers.
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