But to take advantages of these developments, practitioners need to be educated about all the aspects relating to osteoporosis, and the public has to be made aware of the problem and the promise of new approaches and therapies.

Included in these needs are the following:

Recently, the North American Menopause Society addressed all these aspects in their 2010 osteoporosis position statement*. That paper is at best a summary of recommendations and certainly is recommended reading. However, a position statement is not a textbook, and does not have the luxury of long explanations or clear diagrams and illustrations. This new textbook takes that role, and achieves it admirably. The clinician will find detailed reviews and clinical recommendations on all the issues listed above.

fm12Osteoporosis, especially prevalent among older postmenopausal women, increases the risk of hip and spine fractures, associated with particularly high morbidity and mortality in this population. Thus, the primary goal of osteoporosis therapy is to prevent fractures. This mandates slowing or stopping bone loss, maintaining bone strength and minimizing or eliminating factors that may contribute to fractures. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. The most common risk factors for osteoporotic fracture are advanced age, low bone mineral density and previous fractures as an adult. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake, and fall prevention. If pharmacologic therapy is indicated, then government-approved options are bisphosphonates, selective estrogen-receptor modulators, parathyroid hormone, estrogens and calcitonin.

It is for me a privilege and pleasure to have been given this opportunity to provide this opening insight to a problem of such critical importance and relevance in a world with an aging population. Every practitioner should read, comprehend, and take into active practice the pearls of wisdom presented within the following pages.

As a clinician looking after women's health, I realize that it is a daunting yet an essential task to instill the practice of preventive medicine in routine clinical care. Menopause is a biological and a recognizable event, hence, gives the clinician an opportunity to provide comprehensive health care at this stage.

The hypothesis that menopause transition accelerates the development of chronic disease is well supported by epidemiological, observational, clinical and randomized controlled trials. The average age at menopause in India is estimated as 46 years, much earlier as compared to 51 years in the Caucasian population. According to the World Health Organization health statistics for 2011 in India, the average female life-expectancy in 2011 is 68 years and is projected to increase to 73 years by 2021. It is also important to understand that the mean bone mineral density in the Indian women is about two standard denomination lower than the Caucasians. It is not surprising that osteoporotic fractures occur a decade earlier in Indian women. Another factor in India is the prevalence of malnutrition and vitamin D deficiency which adds to the increased prevalence of low bone mass. The prevalence of osteoporosis in the age group of 30–60 years is approximately 29% in India and the prevalence of low bone mass above the age of 50 years is estimated to be 50%.

fm14Faced with these figures and the increase in the aging population, it is important for the health care providers to be updated on the issues of management of chronic disorders, postmenopausal osteoporosis being one of them. Postmenopausal osteoporosis, unlike senile osteoporosis, is primarily due to estrogen deficiency leading to accelerated trabecular bone loss resulting in an increased risk of fractures in the wrist, spine and hip.

Osteoporosis is an evolving, complex, endocrinological disorder. Postenoppausal osteoporosis is called the silent epidemic, for it has a long window period and the first clinical manifestation of the disease is a fragility fracture. Treatment strategies are based on events which occur far in the future, hence, long-term compliance is a difficult issue to deal with. In the management of osteoporosis, the focus is to prevent the first fragility fracture and prevent further fracture if one has already occurred by stabilizing and increasing the bone mass.

Postmenopausal osteoporosis—is it a no man's land or responsibility of every health care provider dealing with women's health? Whose domain does it fall into? The endocrinologist, rhuematologist, physician, gynecologist, pediatrician, orthopedician, physiotherapist, nutritionist? All of them, since preventive measures start at an early age and being multifactorial, specialists from different specialities should be involved in the management of postmenopausal osteoporosis. Osteoporosis has long been considered as “A pediatric disease with a geriatric consequences” but now we need to rephrase and probably say that it is “An in utero disease with geriatric consequences”. This statement implies that its neither too early to start preventive measures nor too late to start treatment of osteoporosis.

In the Gail's model, the female life-expectancy by screening mammogram is increased by one month, occult blood testing by two months, Pap smear by three months, and by treating osteoporosis by six months to three years. All the above facts are intended to infuse interest to read, understand and manage postmenopausal osteoporosis.

I am fortunate to have a galaxy of distinguished contributors from different parts of the globe. Each one of them is an excellent academician and a dedicated clinician working in women's health. My sincere thanks to each one of them for their valuable time and contribution. I am fortunate and obliged to Dr Wulf H Utian, a legend in menopausal medicine, to have written the Foreword. I am grateful to my family for the unconditional support in my endeavors.

For any query, complement or advice, please mail at drmeeta919@gmail.com