Osteoporosis and its management in older women

Osteoporosis is not an inevitable accompaniment of aging. Rather, it evolves silently over a lifetime, with its attendant morbidities occurring late in life. It is no longer the standard of care to wait until the primary morbidity strikes to begin therapy. A better outcome is always achieved when the individuals at risk are identified early, lessening or even preventing morbidity such as osteoporotic fractures. Recent surveys show a reluctance on the part of many physicians to diagnose or treat osteoporosis in their patients. A second level of resistance is often seen even after fractures occur. Either scenario is particularly unfortunate as therapies currently exist that can significantly reduce future morbidity and probably mortality. Physicians must recognize that patients who have had one fracture are at significantly greater risk to sustain more fractures and are more likely to suffer chronic debilitating musculoskeletal failure. Therefore, in the elderly fracturing patient, even more intensive intervention (fracture prevention) is required.