Osteoporosis mangement

About 40% of women who reach the age of 50 are expected to suffer from oste oporosis during their remaining life. The morbidity associated with hip, sp inal and wrist fractures, resulting from osteoporosis, and the mortality re sulting from hip fractures justify the development of prevention strategies . Optimal management of osteoporosis consists of maximizing peak bone mass in early adulthood and preventing the rapid bone loss that occurs soon afte r the menopause. Peak bone mass will be reached in most women if adequate n utrition is taken and exercise is encouraged, while major risk factors are avoided. At the menopause, prescription of hormone replacement therapy (HRT ) constitutes the primary prevention strategy. There ape, however, question s that remain unanswered or debated. What is the optimal dose of HRT, when should it be started, and for how long should it be maintained? In women wh o do not, or may not, take HRT, and who have osteoporosis, alternative ther apeutic options include diphosphonates (e.g., alendronate) and Selective Es trogen Receptor Modulators (such as raloxifene). Other treatments to restor e bone strength in women with established disease may also reduce the risk of fractures. Some of them, such as calcitonin, may clot be cost effective. Others have produced conflicting data (fluoride) and others are still unde r evaluation (PTH or strontium). In sunlight-deprived, vitamin D-deficient elderly nursing home residents, dietary supplementation of calcium and vita min D has been shown to prevent bone loss and fractures. Strategies to avoi d falls should also be encouraged for these patients.