TRANSIZIONE PERIMENOPAUSALE: METABOLISMO SCHELETRICO, RISCHIO OSTEOPOROTICO E DI FRATTURA

The menopausal transition represents a critical phase of woman life with a variable length (months or years) characterized by a subfertile condition with ovarian endocrine instability. This phase signs the transition from fertile age to unfertile postmenopause. During the menopausal transition this endocrine instability, characterized by alternate phases of low estrogen production with phases of estrogen excess, signals however a global tendency to a decrease of estrogen production. Bone metabolism already in perimenopause is oriented toward negative balance with an increase bone turnover with high reasorption osteoclastic activity not sufficiently compensated by the increased osteoformation. This phenomenon leads to accelerated bone loss at prevalent trabecular skeletal sites (vertebrae, appendicular bones). This bone loss is key risk factor for bone fragility (osteoporosis) and fracture. Preliminary clinical evaluation of all risk factors for bone loss (in addition to estrogen deficiency) is relevant to establish the correct diagnostic-therapeutic approach to menopausal osteoporosis. This allows to realize efficient “passive prevention” in all women with correction of modifiable risk factors and to select women candidate to vertebral/ femoral densitometry by DXA (Double X-ray Absorptiometry). The integrated evaluation of bone density with main fracture risk factors independent of bone density (age, low weight, corticosteroids, personal and familiar history of atraumatic fractures, current use of smoke or alcohol , rheumatoid arthritis) permits to estimate with efficacy the 10-year risk absolute fracture and to personalize the therapeutic/counselling strategy.