Management of osteoporosis. An overview

Osteoporosis is a common disease associated with aging and menopause, and is becoming a major health and socioeconomic problem worldwide. The 2 major determinants of risk of osteoporosis are peak bone mass (reached in the third decade of life) and bone loss thereafter. There is substantial evidence that bone mass is of major importance for the strength of bone and the risk of fracture. The measurement of bone mass in the third decade of life is therefore a potentially useful tool in assessing the individual risk of fracture. Moreover, biochemical markers of bone formation and resorption may be of some use in predicting the rate of bone loss and the response to therapy. Since the most well-defined risk factor for osteoporosis is the cessation of ovarian estrogen production at menopause, estrogen replacement therapy (ERT) is the treatment of choice for postmenopausal bone loss. While the benefits of ERT in preventing bone loss and reducing the incidence of fractures are well established, such therapy is contraindicated in some women and is not an acceptable option for others. Other widely used treatments for osteoporosis that have been utilised to prevent bone loss include calcitonin and bisphosphonates, calcium supplementation, ossein-hydroxyapatite compound, vitamin D analogues, sodium fluoride, parathyroid hormone, anabolic steroids and growth hormone. While ERT is presently the best option for the prevention of bone loss, a regimen of ERT combined with lifestyle changes (e.g. exercise and diet) as well as other bone-preserving drugs may increase bone mass in postmenopausal women to a greater extent than ERT alone.