THE MANAGEMENT OF OSTEOPOROSIS

The management of osteoporosis used to centre upon investigation and t reatment of patients with fracture. The spectrum has now widened to in clude the detection of patients at high risk of fracture before a frac ture occurs, This is best achieved by consideration of clinical risk f actors and the selective use of bone densitometry. The frequency of os teoporotic fractures in elderly women is such that detailed investigat ion of such patients is often not necessary unless the patient's bone density is outside the normal range for age. When bone density is inex plicably low, secondary causes of osteoporosis should be sought by app ropriate investigations. Fracture prevention involves a correction of lifestyle factors (stopping smoking, moderating alcohol intake etc.) a nd achieving a total calcium intake of 1-1.5g/day. The first line for pharmacological intervention is hormone replacement therapy because of its proven efficacy and the extensive data available documenting its safety. The bisphosphonates have comparable effects on bone density an d fractures in studies extending for up to 3 years, and are increasing ly used, particularly in older patients and those reluctant to take ho rmone replacement therapy. Other available agents have significant dra wbacks, either with respect to side-effects or inconsistent documentat ion of efficacy and should be used only in special circumstances.