Osteoporosis: an updated approach to prevention and management

Osteoporosis is a major public health problem whose impact will only continue to increase in the United States. Current evidence indicates that estrogen therapy will prevent bone loss and reduce the incidence of fractures. The major problem is identification of those most at risk of fracture. Currently, risk factor assessment and bone mass measurement used in combination offer the closest approximation to the ideal, although it is not yet completely clear how good identification is. Together these estimates of risk need only be used for those about whom there is a question concerning the use of estrogen, and need not be used for patients who have either already decided to initiate preventive treatment or have decided not to start such a program.