[Osteoporosis. Detection, prevention, and treatment]

The osteoporotic syndrome is characterized by a reduction in quantity (osteopenia) and damage of the quality (microarchitecture) of bone mineralization. These are heterogeneous disturbances caused by multiple not well known metabolic causes. It is diagnosed by the presence of bone deformations or non-traumatic fractures. The early detection of osteopenia is important and it is considered that individuals whose bone mineral density (BMD) is lower than 80% of the normal value, are more exposed to fractures. Serum alkaline phosphatase, hydroxyproline and urinary pyridolines are biochemical markers. Nutritional aspects and physical movements are emphasized to obtain a larger bone mass, specially during the growing period. It is absolutely necessary to ingest enough quantity of calcium and in the southern regions of the country consumption of Vitamin D must be increased. Therapeutical resources tend to prevent osteopenia more effectively. Estrogens are greatly used in postmenopausic women for the prevention but not for the treatment of osteoporosis once established. They are effective but there still exist some doubts about the innocuousness of long term treatments. Calcitonines increase vertebral mineralization temporarily and may be used as alternatives of replacement hormonal therapies. Bisphosponates present different mechanisms, for example, pamidronate is not cytotoxic and for this reason does not interfere in the remodelling process, which is absolutely necessary to maintain or improve the architectural quality of the bone. The effect of bisphosphonates on mineralization is lasting. As they are new drugs, they have not yet been definitely approved in every country. Fluorine salts have always produced controversial results, some favourable initial effects do not prevent adverse consequences in a long treatment. Vitamin D, gallium nitrate and ipriflavone produce fairly good results, which must still be compared with those of the more active agents. The use of other drugs (tamoxifeno, parathormone, growth factors, thiazide and inhibitors of the proton pump) is still under development. It is concluded that osteoporosis is a pathologic process of ageing, for which there are pharmaceutical products available, specially to prevent osteopenia and bone damage.