骨质疏松症影响着美国的许多绝经后妇女。通过临床评估和双能X线吸收法测量的骨矿物密度扫描进行筛查。口服治疗适用于在筛查后被认为具有增加患病风险的人群，可以预防病理性骨折。目前，包括阿仑膦酸盐、伊班膦酸盐和利仁膦酸盐在内的双膦酸盐类药物是骨质疏松症诊断后的一线口服治疗药物。激素疗法包括含雌激素的治疗方法、选择性雌激素受体调节剂以及其他模拟雌激素作用的化合物，如替伯隆。生活方式的改变，如补充剂和体育锻炼，也可能对预防骨质疏松症起到辅助治疗的作用。这些治疗方法主要受到其不良反应的限制。治疗方案应根据患者所示明显风险因素、不良反应以及对治疗的临床反应进行个体化调整。与药物选择相关的最严重风险因素主要涉及激素替代治疗，其中存在静脉血栓形成、冠心病、乳腺癌和子宫癌的担忧。双膦酸盐最常见的副作用是胃肠不适，通过适当的用药可以缓解。尽管存在副作用，这些药物已被证实在绝经后妇女中预防椎体和非椎体骨折方面具有疗效。骨折风险应该与每个方案的不良事件风险进行权衡，临床判断应根据患者的目标和经验来确定治疗方法。版权所有 © 2023年，Schroeder等人。

Osteoporosis affects a significant number of postmenopausal women in the United States. Screening is performed using clinical assessments and bone mineral density scans via dual x-ray absorptiometry. Oral therapy is indicated to prevent pathologic fractures in those deemed at increased risk following screening. Bisphosphonates including alendronate, ibandronate, and risedronate are currently first-line oral therapeutics in fracture prevention following the diagnosis of osteoporosis. Hormonal therapies include estrogen-containing therapies, selective estrogen receptor modulators, and other compounds that mimic the effects of estrogen such as tibolone. Lifestyle modifications such as supplementation and physical activity may also contribute to the prevention of osteoporosis and are used as adjuncts to therapy following diagnosis. These therapeutics are limited primarily by their adverse effects. Treatment regimens should be tailored based on significant risk factors demonstrated by patients, adverse effects, and clinical response to treatment. The most severe risk factors relevant to pharmacological selection involve hormone replacement therapies, where concern for venous thrombosis, coronary artery disease, breast, and uterine cancer exist. Bisphosphonates are most commonly associated with gastrointestinal discomfort which may be mitigated with proper administration. Although adverse effects exist, these medications have proven to be efficacious in the prevention of vertebral and non-vertebral fractures in post-menopausal women. Fracture risk should be weighed against the risk of adverse events associated with each of the regimens, with clinical judgment dictating the treatment approach centered around patient goals and experiences.Copyright © 2023, Schroeder et al.