Publication:

Comprehensive review of postmenopausal osteoporosis: molecular mechanisms, lifestyle interventions and pharmacological advances

Postmenopausal osteoporosis is a major public health concern characterized by decreased bone mineral density (BMD) and deterioration of bone microarchitecture, leading to increased fragility and fracture risk. The condition is primarily driven by estrogen deficiency following menopause, which disrupts the balance between bone resorption and bone formation. This review provides a comprehensive overview of the molecular and physiological mechanisms underlying postmenopausal osteoporosis, including the roles of osteoclast activation, inflammatory cytokines, oxidative stress, and key regulatory pathways such as RANK/RANKL/OPG and Wnt/β-catenin signaling. In addition to the biological mechanisms, the review examines important lifestyle factors that influence bone health, including nutrition, adequate calcium and vitamin D intake, physical activity, and fall-prevention strategies. Evidence supporting weight-bearing and resistance exercise as effective non-pharmacological interventions for maintaining or improving BMD is discussed. The article also reviews current pharmacological treatments for postmenopausal osteoporosis, including antiresorptive agents such as bisphosphonates and denosumab, as well as anabolic therapies such as teriparatide and romosozumab. In addition, the role of hormone replacement therapy (HRT) is considered as a therapeutic option for postmenopausal women. HRT can reduce bone loss by compensating for estrogen deficiency and has been shown to improve BMD and reduce fracture risk. Emerging therapeutic approaches and future directions in osteoporosis research are also highlighted. Understanding the complex interactions among hormonal changes, molecular pathways, lifestyle factors, and pharmacological therapies is essential for improving prevention strategies and optimizing clinical management of postmenopausal osteoporosis.