Native American women (20% higher than the national average) and non-Hispanic White women (6% higher than the national average) are at highest risk of low bone mass and fracture. Most studies have examined race and ethnicity only via self-report methods and are therefore to be considered social constructs. 9īone loss rates and risks of fracture vary between racial and ethnic groups. 8 Taken together, age and menopause conspire to reduce a woman’s bone density by 30% by the time she is 80 years old. 7 The impact of menopause is so significant that the number of years elapsed since a woman’s final menstrual cycle is a better predictor of bone density than her chronological age. Thereafter, the rate of bone loss slows considerably, to an average of 0.5% per year. 7 During transmenopause, which begins about 2 years before a woman’s final menstrual period and lasts for several years afterward, women sustain an average annual rate of bone loss of 10% to 12% at both the hip and spine (Figure). Prior to the menopausal transition, they lose bone at an average annual rate of 2%, but there is substantial variation depending on genetic, lifestyle, and environmental factors. Women attain peak bone mass at around 35 years. Osteoporosis arises when resorption exceeds formation long enough to result in a weakened bone that is susceptible to breakage. Bone is in a constant state of remodeling and repair, concurrently undergoing formation and resorption processes. The word osteoporosis (literally, “porous bones”) defines the condition’s pathophysiology. 6 It is clearly imperative, then, that the obstetrician-gynecologist understand the condition, its detection, and its treatment. 5 The cost of providing care for Medicare beneficiaries in 2018 was estimated to be $57 billion. 4 Fully 30% of Medicare beneficiaries who had a hip fracture in 2016 died within 12 months. 2 Moreover, about 50% of women will sustain an osteoporotic fracture during their lifetime, 3 resulting in an increased risk of further morbidity and mortality. 2 Given the projected aging of the population, it is estimated that by 2030 over 70 million US adults will have low bone mass or osteoporosis. In 2010, an estimated 10.2 million US adults aged 50 years and older had osteoporosis, and an additional 43.4 million had low bone mass. However, women (individuals assigned female at birth who possess ovaries) undergo a transmenopausal period of accelerated bone loss ( Figure), 1 which, combined with their overall smaller bones compared with men, makes them far more susceptible to osteoporosis and subsequent fractures. Thereafter, both lose bone mass in a slowly progressive manner. Bone accrual occurs in men and women from early life till well into their fourth decade.
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