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Strategy for the Management of Osteoporosis

  • Review Article
  • Guidelines
  • Published:
Disease Management & Health Outcomes

Summary

The main consequence of osteoporosis is fracture, which is due to loss of bone mass and microarchitecture upon which mechanical integrity depends. The management of osteoporosis care focuses either on preventing bone loss (and thereby preserving mechanical integrity) or targets those who have lost a significant amount of bone and have had, or are at imminent risk of, a fracture.

The prevention of osteoporosis is centred on primary care where the opportunities to identify those at risk should be included in normal clinical practice. For many patients, treatment can be started in primary care without recourse to hospital referral.

Hormone replacement therapy (HRT) is the mainstay of treatment. Introduction early in the menopause is good for compliance but this wanes with time and few women will take treatment for more than 10 years. Protection from osteoporosis will then decline as they reach later life when major fractures have their peak incidence. It may be that HRT or other agents like the selective estrogen receptor modulators should be introduced for the first time in later life but this will require different strategies to achieve compliance.

Treatment of established bone loss also requires the identification in primary care of those most at risk in both primary prevention and treatment of osteoporosis, bone mineral density measurements are critical to the evaluation of risk. Since bone loss is an inevitable consequence of aging, osteoporosis is so common in the elderly that treatment must be directed at those most at risk of a fracture. The bisphosphonates which are potent inhibitors of bone resorption have been shown to increase bone mass and reduce major fractures and play a key role in management. Unfortunately none of the bisphosphonates, nor any of the other agents used for treating osteoporosis (HRT, vitamin D, calcitriol, calcitonin) have been directly compared in fracture prevention studies and the relative merits of these agents have to be derived from individual trials which often differ in major respects.

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Authors and Affiliations

  1. Division of Mineral Metabolism, City Hospital, Nottingham, England

    Opinder Sahota, Cornelle R. Parker &  David J. Hosking

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  2. Cornelle R. Parker
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  3. David J. Hosking
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Sahota, O., Parker, C.R. & Hosking, D.J. Strategy for the Management of Osteoporosis. Dis Manage Health Outcomes 1, 241–253 (1997). https://doi.org/10.2165/00115677-199701050-00003

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