The brittle bone: how to save women from osteoporosis

For a woman, the risk of suffering an osteoporotic fracture during her lifetime is higher than the combined risk of breast, endometrial, and ovarian cancer. It is important to reduce the number of osteoporosis-related fractures. Therefore, it is necessary to emphasize various interventions and attitudes which will decrease both the risk of falling and that of breaking bones. Strategies should be followed to reach adulthood with an optimal bone mass through improved diet and exercise during childhood. Programs that identify women with the lowest bone mass at the time of menopause may be useful, since prophylactic measures against osteoporosis such as hormone replacement therapy (HRT) can be offered to them. Identification of women at risk can be achieved through bone densitometry; a decrease of each standard deviation of bone mineral mass below mean values predicts a doubling of the fracture risk. Some data suggest that physicians are more willing to prescribe HRT specifically to women with the lowest bone mass, and that the latter are more likely to stay on therapy for longer periods of time. The decision to use HRT should be taken by the patient after proper information of all benefits (diminished climacteric symptoms, decrease of cardiovascular risk) and potential risks (possible enhanced breast cancer risk, appearance of side effect). In women who do not want to take HRT, or for whom contraindications exist, alternative medications, such as calcium, vitamin D and biphosphonates can be considered, depending on fracture risk. For older and institutionalized women, programs should be developed to decrease the risk of falling. Likewise, it may be possible to reduce the consequences of a fall, for instance by promoting the development of energy-absorbing hip pads, which reduce fracture risk.