Prevention of osteoporosis. Current recommendations

Osteoporosis and its treatment have attracted much attention in recent years, especially since the widespread recognition of its association with the menopause. The resulting fractures are a cause of considerable morbidity and mortality in the elderly, and current costs of treating these patients has been estimated to be in excess of pounds 500 million per annum in the UK. As the causes of osteoporosis are now recognised the condition may be largely preventable, especially in women, and significant savings in health expenditure could be made if preventive methods are applied to those most at risk. The most well researched preventive treatment for osteoporosis is hormone replacement therapy (HRT) which offers additional benefits to those who choose it. Alternative methods currently under investigation for those who cannot or will not use HRT include those agents which inhibit the resorption of bone and those that stimulate the production of new bone. Treatment of established disease, i.e. attempts at increasing bone density in those with significant loss, is more difficult and methods so far investigated are not without risks and adverse effects. Furthermore, whether an increase in bone mineral density results in a reduced rate of fracture incidence has yet to be confirmed.