PHARMACOLOGIC THERAPY OF POSTMENOPAUSAL OSTEOPOROSIS: AN UPDATED NARRATIVE REVIEW OF GUIDELINES AND EVIDENCE

Postmenopausal osteoporosis is a highly prevalent skeletal disorder that confers a substantial burden of fragility fractures, disability, loss of independence, and mortality. Over the past two decades, several potent antiresorptive and osteoanabolic agents have transformed clinical care. Yet, real-world treatment gaps persist and the optimal choice, sequencing, and duration of therapy remain the subject of evolving guidance. This narrative review synthesizes contemporary international and national guideline recommendations, pivotal randomized trials, and extension studies bearing on the pharmacologic management of postmenopausal osteoporosis.We discuss oral and parenteral bisphosphonates, denosumab, teriparatide and abaloparatide, romosozumab, selective estrogen receptor modulators (SERMs), menopausal hormone therapy, and calcitonin, with emphasis on efficacy against vertebral, nonvertebral, and hip fractures; time to benefit; adverse effects including atypical femoral fractures and osteonecrosis of the jaw; drug holidays; and the increasingly important concepts of sequential and goal-directed therapy.