Four experts share their advice for managing osteoporosis and osteopenia in the clinic—and explain what’s new in the treatment pipeline.

MHT is often first line

Bone remodelling involves a balance between the activity of osteoclasts, which resorb bone, and osteoblasts, which build it.

After peak bone mass is reached at about 30 years of age, resorption gradually predominates, explains Dr Sonia Davison, lead endocrinologist at Jean Hailes for Women’s Health and Past President of the Australasian Menopause Society.

Oestrogen reduces osteoblast apoptosis and increases osteoclast apoptosis, helping preserve bone. Menopausal hormone therapy is therefore often considered first-line in appropriate women, she explains.

“That’s usually the first thing I will offer if otherwise appropriate for the patient up until the age of 60 years.”

Professor Bronwyn Stuckey, Consultant Endocrinologist at Sir Charles Gardner Hospital, Medical Director of the Keogh Institute for Medical Research and Clinical Professor in the University of Western Australia’s medical school, agrees.

“My usual discussion is oestrogen will be good for your bones, your glucose metabolism, your lipids, your arthritis, your sleep––all those things that go on after menopause,” she says.

GP Dr Jane Elliott, Clinical Senior Lecturer in Obstetrics and Gynaecology at the University of Adelaide, stresses MHT is indicated for treatment of osteopenia and osteoporosis irrespective of whether women have menopausal symptoms.