Osteoporosis: preventive strategies.

In the United States alone, osteoporosis affects over 20 million women. The cost of treating the complications of osteoporosis exceeds 10 billion dollars. Half of those who sustain a hip fracture never return to their former life style. In addition, there is a major increase in mortality within the first year of a hip fracture. These facts dictate an urgent need to address issues relevant to the prevention of osteoporosis. Only by preventing bone loss will it be possible to meet the challenge of dealing effectively with this major public health problem. There are three major components of an effective preventive strategy. The first is to ensure that optimal peak bone mass is achieved during childhood, adolescence and early adulthood. Although much of peak bone mass is determined by genetic influence, there are other factors of importance over which one has control. These include adequate dietary calcium intake, good nutrition, exercise and hormone sufficiency. The second aspect to prevention is maintaining bone mass that has been acquired. Bone maintenance requires adequate calcium intake and exercise as well as avoiding tobacco and excessive alcohol. Certain diseases (i.e., hyperthyroidism) and medications (i.e., steroids, anticonvulsants) will tend to erode the repositories of bone at any time in life. The third aspect to prevention is counteracting the process of age-related bone loss that occurs after 40-45 years of age. In women, the menopause markedly accelerates bone loss. Measures to ensure that bone loss is minimized during the middle years and beyond include adequate nutrition (vitamin D and calcium) and hormone sufficiency. For women, hormone replacement therapy is a gold standard of therapy because it arrests bone loss associated with the menopause. For women who cannot or will not take estrogen, newer, effective approaches, such as estrogen analogues and the nonhormonal bisphosphonates, are available. With this three-phased approach, requiring constant attention to bone health over one's entire life, the risk of developing osteoporosis and its complications can be minimized.