[Prevention and treatment of osteoporosis]

Despite the fact that osteoporosis is a common disease and an important cause of morbidity and mortality, that screening tests are available which are safe and acceptable to patients, and that effective therapy is possible, osteoporosis remains a controversial subject. The Dutch Health Advisory Board (Gezondheidsraad) recently submitted to the Ministry of Health a balanced and comprehensive report to remedy this controversial situation. As often in a consensus report made by a variety of experts, completeness is assured but the necessary relevance of the statements and the feasibility of the therapeutic recommendations are not always clear. Based on personal experience, clinical practice and research in osteoporosis, the author formulates a number of messages which complement the report. The following messages are elaborated: osteoporosis is a silent thief; backache during the menopause is not always osteoporosis; detection of the patient at risk for osteoporotic fractures is possible; primary osteoarthrosis protects against osteoporosis; bone densitometry has given osteoporosis a scientific cachet; bones are not stones, effective prevention and treatment are possible, there are alternatives to calcium and hormone replacement therapies. There is still much to learn about osteoporosis and its treatment. Nevertheless, there is a great deal that is known and we need to give the best advice we can in the light of this knowledge.