Treatment of Osteoporosis in Postmenopausal Women Under 60 with Vasomotor Symptoms or High Breast Cancer Risk
Managing osteoporosis without pathological fractures in postmenopausal women under 60 requires careful selection of second-line therapy based on the patient's specific symptom profile and individual risk factors.
This protocol applies to postmenopausal women under 60 years of age who either have vasomotor or genitourinary symptoms of menopause — making them candidates for hormone replacement therapy — or carry a high risk of breast cancer combined with a low risk of venous thromboembolism, where a selective estrogen receptor modulator may be the more appropriate choice.
Second-line therapy in this population centres on hormonal replacement approaches or selective estrogen receptor modulators, with the primary clinical objective of vertebral fracture prevention. The specific agents, selection criteria, and complete evidence-based regimen are available in the full protocol.
References
DOI: 10.1136/bmj‐2024-081250
The use of HRT or tibolone is currently limited to women <60 years with vasomotor or genitourinary symptoms of menopause or for the treatment of osteoporosis in postmenopausal women in whom non-estrogen drugs are not considered to be appropriate.
Indications for their use may include postmenopausal women with low risk of venous thromboembolism for whom non-estrogens are not appropriate and who have high risk of breast cancer (raloxifene and lasofoxifene) or significant vasomotor symptoms (bazedoxifene with conjugated estrogen).
Second line therapies: HRT for postmenopausal women <60 years with vasomotor symptoms, SERMs if high risk of breast cancer, SERMs and ibandronate for vertebral fracture prevention only.
Selective estrogen receptor modulators (SERMs) such as raloxifene and bazedoxifene have the additional benefit of exerting estrogen receptor antagonistic or neutral effects in the breast and endometrium.
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