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1. Bone loss in women accelerates at the onset of menopause on average at a rate of approximately 3% per year for the first 5 years and 1% per year thereafter. Hip fractures frequently occur 15-25 years after menopause and result from the reduced bone mass. Other fractures associated with osteoporosis include fractures of the vertebrae, distal forearm, and proximal humerus.

2. Osteoporosis is diagnosed when bone mineral density decreases to less than 2.5 standard deviations below the young adult peak mean. Estrogen therapy has been shown to be effective in preventing bone loss.

E. Genitourinary symptoms. Withdrawal of estradiol during menopause results in thinning of the mucosal layer. The vaginal and urethral mucosa appear pale, dry, and flattened. These changes are associated with vaginal dryness, dyspareunia, atrophic vaginitis, urethritis, and urinary incontinence. Use of systemic estrogen replacement or local estrogen creams and urethral suppositories can reverse these changes.

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