The diagnosis and management of osteoporosis

Osteoporosis is a prevalent disease, which can cause considerable morbidity due to osteoporotic fractures. Knowledge of the cause of osteoporotic bone loss would help implementation of the appropriate treatment. There are two pathogenic mechanisms involved in the development of osteoporosis: 1) achi evement of a relatively low peak bone density in young adulthood which incr eases the risk of osteoporosis because only a modest bone loss later in lif e results in bone densities in the osteoporotic range, and 2) a rapid bone loss rate at menopause and/or later in life. Most patients exhibiting osteo porosis have some combination of these two pathogenic mechanisms. There are basically two causes for osteoporosis: 1) a normal peak bone mass with rap id bone loss, and 2) low peak bone mass with a normal bone loss rate. Prope r management of osteoporosis involves early diagnosis of the disease and ap propriate treatments. With respect to diagnosis of osteoporosis, we now hav e two important diagnostic tools: a) instruments that measure bone density with high precision, and b) serum and urine biochemical markers of bone for mation and resorption assays that allows rapid and frequent monitoring of b one turnover rates. Bone density measurements allow the diagnosis of osteop orosis before fractures occur. Biomarkers can identify patients with a high bone turnover, a situation that leads to rapid bone loss. These two diagno stic tools together can help identify osteoporosis in its earliest form so that preventative measures can be instituted. With respect to treatment of osteoporosis, we now have several forms of effective therapies, such as est rogens, bisphosphonates, calcitonins, and vitamin D (and/or active vitamin D metabolites), that are approved for the use in the prevention and/or trea tment of osteoporosis. Consequently, most patients with osteoporosis can no w be treated with effective therapies that will have a positive impact on t he disease.