延长的寿命意味着女性在她们生命的大约三分之一时间内处于低雌激素状态。在这段时间内，整体健康以及骨骼健康会随着衰老和接触各种风险因素而发展。在本综述中，我们提供了一种综合护理模型中对骨质疏松症的顺序管理方法的概述，以便为医生提供一个有用的工具来促进治疗决策。目前的证据表明，药物治疗应根据骨折风险进行选择，而这并不总是与年龄相关的。由于它们对骨转换和其他激素调节现象（如潮热或乳腺癌风险）的影响，我们将激素治疗和选择性雌激素受体调节剂定位为早期绝经后干预治疗骨质疏松症的方法。当不能使用这些药物时，有令人信服的证据支持抗重吸收剂作为绝经后骨质疏松症的一线治疗方法，在许多临床情况下，消化系统情况、肾功能、对治疗的准备情况或患者个人偏好在选择双膦酸盐或德诺珠单抗之间起着作用。对于有高骨质疏松性骨折风险的患者，“先靓骨再减吸收”的方法可以降低这种风险。这些骨形成药物或德诺珠单抗对骨骼健康的作用应与随后使用的抗重吸收剂一起加强。无论采取何种策略，随访和治疗应持续进行，以帮助预防骨折。版权所有 © 2023. Elsevier B.V. 发布。

Increased life expectancy means that women are now in a hypoestrogenic state for approximately one-third of their lives. Overall health and specifically bone health during this period evolves in accordance with aging and successive exposure to various risk factors. In this review, we provide a summary of the approaches to the sequential management of osteoporosis within an integrative model of care to offer physicians a useful tool to facilitate therapeutic decision-making. Current evidence suggests that pharmacologic agents should be selected based on the risk of fractures, which does not always correlate with age. Due to their effect on bone turnover and on other hormone-regulated phenomena, such as hot flushes or breast cancer risk, we position hormone therapy and selective estrogen receptor modulators as an early postmenopause intervention for the management of postmenopausal osteoporosis. When the use of these agents is not possible, compelling evidence supports antiresorptive agents as first-line treatment of postmenopausal osteoporosis in many clinical scenarios, with digestive conditions, kidney function, readiness for compliance, or patient preferences playing a role in choosing between bisphosphonates or denosumab during this period. For patients at high risk of osteoporotic fracture, the "anabolic first" approach reduces that risk. The effect on bone health with these bone-forming agents or with denosumab should be consolidated with the subsequent use of antiresorptive agents. Regardless of the strategy, follow-up and treatment should be maintained indefinitely to help prevent fractures.Copyright © 2023. Published by Elsevier B.V.