OSTEOPOROSIS - PREVENTIVE STRATEGIES

In the United States alone, osteoporosis affects over 20 million women . The cost of treating the complications of osteoporosis exceeds 10 bi llion dollars. Half of those who sustain a hip fracture never return t o their former life style. In addition, there is a major increase in m ortality within the first year of a hip fracture. These facts dictate an urgent need to address issues relevant to the prevention of osteopo rosis. Only by preventing bone loss will it be possible to meet the ch allenge of dealing effectively with this major public health problem. There are three major components of an effective preventive strategy. The first is to ensure that optimal peak bone mass is achieved during childhood, adolescence and early adulthood. Although much of peak bone mass is determined by genetic influence, there are other factors of i mportance over which one has control. These include adequate dietary c alcium intake, good nutrition, exercise and hormone sufficiency. The s econd aspect to prevention is maintaining bone mass that has been acqu ired. Bone maintenance requires adequate calcium intake and exercise a s well as avoiding tobacco and excessive alcohol. Certain diseases (i. e., hyperthyroidism) and medications (i.e., steroids, anticonvulsants) will tend to erode the repositories of bone at any time in life. The third aspect to prevention is counteracting the process of age-related bone loss that occurs after 40-45 years of age. In women, the menopau se markedly accelerates bone loss. Measures to ensure that bone loss i s minimized during the middle years and beyond include adequate nutrit ion (vitamin D and calcium) and hormone sufficiency. For women, hormon e replacement therapy is a gold standard of therapy because it arrests bone loss associated with the menopause. For women who cannot or will not take estrogen, newer, effective approaches, such as estrogen anal ogues and the nonhormonal bisphosphonates, are available. With this th ree-phased approach, requiring constant attention to bone health over one's entire life, the risk of developing osteoporosis and its complic ations can be minimized.