Menopause is the cessation of menstruation, around 50 years of age, due to loss of ovarian follicular function.1 Among the various menopause-related issues, musculoskeletal (MSK) disorders have a pre-eminent role and are becoming a health hazard at midlife. Locomotor disability and frailty-fall-fractures, in fact, entail a compromised quality of life.2 The mechanism by which menopause can lead to MSK disorders is complex and not fully understood. It has been postulated that MSK health in midlife is the result of modifiable and nonmodifiable factors. Among the most relevant modifiable factors, smoking, alcohol intake, insufficient physical activity, ergonomical, psychosocial, and occupational factors play a prominent role.3,4 Nonmodifiable factors are represented by female gender, increasing age, and family history. In both sexes, sexual hormones have a positive regulatory role on bone and muscle health. Estrogen deficiency may lead to a progressive decrease in muscle mass and strength through a variety of pathways, such as, for example, the compromised maintenance of muscle stem cells and their capacity to self-renewal and differentiation into muscle fibers.5 A growing amount of scientific data indicates that estrogen deficiency during menopause is associated with pro-inflammatory cytokines as primary mediators of accelerated bone loss, such as interleukin-1, tumor necrosis factor-alpha, and interleukin-6.6

In this panorama, several diagnostic imaging techniques, such as radiographs, ultrasound, computed tomography (CT) scan, and magnetic resonance imaging (MRI), can be applied for the initial diagnostic assessment and the monitoring of MSK disorders.7 Although nuclear medicine (NM) has a well-established role in the functional imaging of skeletal disease mainly through bone scan, its potential in the field has still to be fully investigated.8 The aim of this review is to provide a comprehensive update of the current applications and future prospects of NM in menopause-related MSK disease. Table 1 summarizes clinical utility of the different imaging modalities in the menopause-related MSK disorders.