DETECTING OSTEOPOROSIS - BEYOND THE HISTORY AND PHYSICAL-EXAMINATION

A number of developments are contributing to clinicians' understanding of osteoporosis as a clinical continuum characterized by low bone mas s and increased risk of fractures rather than as a disease characteriz ed by fragility fractures. With improved capability for accurate measu rement of bone mass, the prevalence of this disease has increased to i nclude at least 25 million Americans. The responsibility of primary ca re physicians to detect and treat osteoporosis has increased according ly. Parents should be counseled regarding their children's diet and li festyle to optimize peak adult bone mass and ensure adequate dietary c alcium intake, Adults should be counseled to minimize behaviors that r esult in accelerated bone loss leg, smoking, alcohol use, anorexia, bu limia). Physicians need to be aware of the serious potential complicat ions of osteoporosis and offer counseling to menopausal women about th e disease and the benefits and risks of hormone replacement and estrog en replacement therapy. Physicians should be familiar with technologie s available in their community for measuring bone mass and recognize t he need to consider prescribing pharmacologic and nonpharmacologic the rapies for patients with low bone mass or osteoporosis. Physicians als o can educate caregivers about prevention of falls and fractures in el derly patients who are unsteady on their feet. Improved technologies f or bone mass measurement and fracture risk assessment, as well as expa nded options for treatment and prevention of osteoporosis, are likely to become available within the next 5 to 10 years, thereby increasing the wisdom of early detection and treatment of osteoporosis.