[Osteoporosis of the lumbar spine]

This brief review demonstrates a positive influence of the treatment modalities established today on postmenopausal, age-related or glucocorticoid-induced bone loss. Measures developing direct anabolic effects are, however, rare. In other words prevention of osteoporosis is more important than therapy. Prevention means above all to change life style, to prevent excessive post-menopausal mineral losses and to treat patients with long-term steroid regimens in higher doses (over 7.5 mg/day). Preventive measures include adequate intake of calcium, reduced intake of salt, encouraging physical activities as well as avoiding excessive alcohol- and nicotine-consumption. From the osteoporotic point of view estrogen substitution is indicated in post-menopausal women. However, an individual evaluation of the indication is mandatory in view of the above discussed aspects. A densitometry-guided follow-up may contribute by valuable data to this decision. Only if these measures fail may further therapeutic and secondary-preventive measures be taken into consideration. Such secondary-preventive measures comprise anti-resorption drugs (calcitonin, higher doses of vitamin D, bisphosphonates) as well as fluoride which stimulates bone remodeling.