European guidance for the diagnosis and management of osteoporosis in postmenopausal women

Overview

This position paper from the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) and the International Osteoporosis Foundation (IOF), published in Osteoporosis International (Kanis et al., 2019), updates the 2013 European guidance on assessing and treating postmenopausal women at risk of fragility fractures. It is designed as a common European framework on which national guidelines can be built, not as a single country protocol.

Diagnosis and fracture risk assessment

The guidance explains the role of bone mineral density measurement, both as the operational basis for diagnosing osteoporosis and as one input into fracture risk estimation. It supports combining bone density with clinical risk factors using fracture probability tools such as FRAX, and reviews newer evidence on assessing bone microstructure. Case-finding strategies and the investigation of patients to identify secondary causes of bone loss are also covered.

Management and monitoring

General measures such as nutrition, physical activity and fall prevention are discussed alongside pharmacological management. The update adds evidence on the long-term effect of dietary intake on fracture risk and on the rise in fracture risk after drug treatment is stopped, which matters for planning treatment duration and follow-up. Approaches to monitoring treatment are reviewed.

Secondary prevention and health economics

The authors highlight Fracture Liaison Services as an organised way to identify and treat patients after a first fragility fracture. A health-economic section considers how treatment can be targeted cost-effectively.

Why it matters

Osteoporosis is common after the menopause, yet many women who sustain a fragility fracture have never been assessed or treated. The guidance aims to close this care gap by making risk assessment systematic, so that treatment reaches the women most likely to benefit.

Who it is for

Endocrinologists, rheumatologists, gynaecologists, orthopaedic surgeons, general practitioners and those planning osteoporosis services.