[Osteoporosis--prevention, diagnosis and treatment. A systematic literature review. SBU conclusions and summary]

A report by the Swedish Council on Technology Assessment in Health Care (SBU) has reviewed, classified, and graded the scientific literature on prevention, diagnosis and treatment of osteoporosis. This article summarizes the overall conclusions. There is no scientific evidence to support the use of bone density measurement as a screening method in healthy, middle-aged individuals. Patients with osteoporosis-related fractures are an undertreated group as regards pharmacotherapy and other interventions to prevent new fractures. There are some evidence that physical exercise to reduce falls among elderly and hip protectors can prevent fractures. The combination therapy of calcium and vitamin D is shown to reduce the risk for hip fractures and other fractures except vertebral fractures in elderly women. Bisphosphonates are shown to reduce the number of fractures, mainly vertebral fractures. SERM is shown to reduce the risk for vertebral fractures in postmenopausal women with osteoporosis. Important risk factors for osteoporosis-related fractures that can be treated are physical inactivity, low weight, tobacco smoking, high alcohol consumption, tendency to fall, impaired vision, low exposure to sunlight, and use of corticosteroids. No particular diagnostic method or measurement site is optimal for determining the risk for fracture in all parts of the skeleton. The various measurement methods--dual energy x-ray absorbtiometry (DXA), ultrasound (QUS), and computed tomography (QCT)--are not directly comparable.