Osteoporosis prevention, diagnosis, and therapy

Objectives To clarify the factors associated with prevention, diagnosis, an d treatment of osteoporosis, and to present the most recent information ava ilable in these areas. Participants From March 27-29, 2000, a nonfederal, nonadvocate, 13-member p anel was convened, representing the fields of internal medicine, family and community medicine, endocrinology, epidemiology, orthopedic surgery, geron tology, rheumatology, obstetrics and gynecology, preventive medicine, and c ell biology. Thirty-two experts from these fields presented data to the pan el and an audience of 699. Primary sponsors were the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health Office of Medical Applications of Research. Evidence MEDLINE was searched for January 1995 through December 1999, and a bibliography of 2449 references provided to the panel. Experts prepared ab stracts for presentations with relevant literature citations. Scientific ev idence was given precedence over anecdotal experience. Consensus Process The panel, answering predefined questions, developed conc lusions based on evidence presented in open forum and the literature. The p anel composed a draft statement, which was read and circulated to the exper ts and the audience for public discussion. The panel resolved conflicts and released a revised statement at the end of the conference. The draft state ment was posted on the Web on March 30, 2000, and updated with the panel's final revisions within a few weeks. Conclusions Though prevalent in white postmenopausal women, osteoporosis oc curs in all populations and at all ages and has significant physical, psych osocial, and financial consequences. Risks for osteoporosis (reflected by l ow bone mineral density [BMD]) and for fracture overlap but are not identic al. More attention should be paid to skeletal health in persons with condit ions associated with secondary osteoporosis. Clinical risk factors have an important but poorly validated role in determining who should have BMD meas urement, in assessing fracture risk, and in determining who should be treat ed. Adequate calcium and vitamin D intake is crucial to develop optimal pea k bone mass and to preserve bone mass throughout life. Supplementation with these 2 nutrients may be necessary in persons not achieving recommended di etary intake. Gonadal steroids are important determinants of peak and lifet ime bone mass in men, women, and children. Regular exercise, especially res istance and high-impact activities, contributes to development of high peak bone mass and may reduce risk of falls in older persons. Assessment of bon e mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. F racture prevention is the primary treatment goal for patients with osteopor osis. Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or c onsequences of falls. Adults with vertebral, rib, hip, or distal forearm fr actures should be evaluated for osteoporosis and given appropriate therapy.