Diagnosis and Treatment of Osteoporosis

Oh, Young Lim

Abstract

Osteoporosis is a silent disease until it is complicated by fractures-fractures that can occur following minimal trauma. Osteoporosis is common among older adults and results in costly osteoporotic fractures. With an ageing population, the medical and socioeconomic effect of osteoporosis, particularly postmenopausal osteoporosis, will increase further Osteoporosis can be prevented and can be diagnosed and treated before any fracture occurs. Importantly, even after the first fracture has occurred, there are effective treatments to decrease the risk of further fractures. Prevention, detection and treatment of osteoporosis should be a mandate of primary care providers. The evaluation of postmenopausal women for osteoporosis risk requires a medical history, physical examination, and diagnostic tests. Major risk factors for postmenopausal osteoporosis (as defined by bone mineral density) include advanced age, genetics, lifestyle factors (such as low calcium and vitamin D intake, smoking), thinness, and menopause status. Management focuses first on nonpharmacologic measures, such as a balanced diet, adequate calcium and vitamin D intake, adequate exercise, smoking cessation, avoidance of excessive alcohol intake and fall prevention. If pharmacologic therapy is indicated, government-approved options are bisphosphonates, a selective estrogen- receptor modulator, parathyroid hormone, estrogens, and calcitonin. Management strategies for postmenopausal women involve identifying those at risk of low bone density and fracture, followed by instituting measures that focus on reducing modifiable risk factors through lifestyle changes and, if indicated, pharmacologic therapy.