THERAPY OF OSTEOPOROSIS - CALCIUM, VITAMIN-D, AND EXERCISE

Calcium supplementation has long been regarded as a fundamental part o f the prevention and treatment of postmenopausal osteoporosis, but it is only in recent years that clear evidence has emerged demonstrating its impact on bone mass, Calcium supplementation does not completely a rrest postmenopausal bone loss but slows the rate of decline by 30 to 50%, The effect of calcium supplementation on fracture incidence in po stmenopausal women has not been established, Vitamin D deficiency is c ommon in the frail elderly, particularly in countries where fortificat ion or food with this vitamin is not practiced, Treatment of vitamin D deficiency has been associated with significant reductions in the num ber of hip fractures, The role of the potent vitamin D metabolites, ca lcitriol and alphacalcidol, in the management of postmenopausal osteop orosis is not clear, Although some studies show substantial benefits i n bone density or fracture rate from the use of these compounds, the p ublished data are inconsistent, In general, hormone replacement therap y and the potent bisphosphonates produce greater effects on bone densi ty and there is a greater consistency among the results of the publish ed studies of these other interventions, Controlled trials of exercise interventions in postmenopausal women show that exercise can positive ly influence bone density by a few percent, Exercise interventions in the elderly have been reported to decrease fall frequency by 10%. This latter effect may have a greater impact on fracture frequency than th e modest benefits of exercise on bone density.