Longevity & AgingRethinking how we diagnose and treat postmenopausal osteoporosis with zoledronate and anabolics
This narrative review from Reid and Bolland updates the management of postmenopausal osteoporosis. It argues that osteoporosis should be diagnosed by fracture risk rather than a bone density T-score below -2.5, since about 80% of women who fracture do not meet that cutoff. Lifestyle measures matter: healthy weight, safe exercise, no smoking, moderate alcohol, and falls prevention. Vitamin D helps mainly when levels fall below about 25-30 nmol/L, while high doses may harm. Bisphosphonates remain first-line, and zoledronate offers long-lasting protection from infrequent dosing. Denosumab works but needs an exit plan because its effect fades quickly. Anabolic drugs, including teriparatide, abaloparatide and romosozumab, are used first for 1-2 years in very high-risk patients, then followed by antiresorptives. The authors stress lifelong, sequenced treatment.
