Menopause and osteoporosis: Epidemiology, pathophysiology, screening and diagnosis.

BACKGROUND: Osteoporosis is a silent disease disproportionately affecting women during peri- and postmenopause due to the associated reduction in oestrogen. It incurs a high fragility fracture risk and financial costs to society. General practitioners (GPs) are well placed to detect this, diagnose it and reduce the subsequent burden of disease. OBJECTIVE: To equip GPs with the understanding of the extent of the disease, pathophysiology and why early detection matters; while further developing screening and diagnostic skills to identify osteoporosis, especially in high-risk women. DISCUSSION: Osteoporosis is the result of resorption- formation uncoupling driven by oestrogen reduction during menopause. The incidence of osteoporosis is increasing. Screening to prevent fractures is essential, especially where risk factors, with a prior fracture being the biggest risk for future fractures, are present. Diagnosis on dual-energy X-ray absorptiometry (DXA) (although not always Medicare reimbursed) is with T-score ≤-2.5. X-rays can complement the work-up because a fragility fracture substantiates a diagnosis.