1-05: Prevention of Osteoporosis

See Chapter 26.

Osteoporosis, characterized by low bone mineral density, is common and associated with an increased risk of fracture. The lifetime risk of an osteoporotic fracture is approximately 50% for women and 30% for men. Osteoporotic fractures can cause significant pain and disability. As such, research has focused on means of preventing osteoporosis and related fractures. Primary prevention strategies include calcium supplementation, vitamin D supplementation, and exercise programs. The effectiveness of calcium and vitamin D for fracture prevention remain controversial, particularly in noninstitutionalized individuals.

Screening for osteoporosis on the basis of low bone mineral density is recommended for women over age 65, based on indirect evidence that screening can identify women with low bone mineral density and that treatment of women with low bone density with bisphosphonates is effective in reducing fractures. However, real-world adherence to pharmacologic therapy for osteoporosis is low: one-third to one-half of patients do not take their medication as directed. Screening for osteoporosis is also recommended in younger women who are at increased risk. The effectiveness of screening in men has not been established. Concern has been raised that bisphosphonates may increase the risk of certain uncommon atypical types of femoral fractures and rare osteonecrosis of the jaw, making consideration of the benefits and risks of therapy important when considering osteoporosis screening.