Prevention and management of osteoporosis

Fractures resulting from osteoporosis are a major public health problem. Physicians should be aware of the chief risk factors for osteoporosis and refer appropriately for bone densitometry. Risk factors include female sex, increased age, previous fracture, family history of fracture, slender habitus, early menopause, treatment with drugs known to affect bone (e.g. glucocorticoids) and diseases known to affect bone (e.g. rheumatoid arthritis). The diagnosis of osteoporosis can be made if the bone density T-score is −2.5 or below. This information can be used with other risk factors to estimate the 10-year risk of osteoporotic fractures. Patients with the highest risk of fracture benefit from many licensed treatments. These can be given orally (alendronic acid, risedronate sodium, ibandronic acid, calcitriol, raloxifene, hormone replacement therapy), subcutaneously (parathyroid hormone, denosumab) or intravenously (ibandronic acid, zoledronic acid), usually with a calcium and vitamin D supplement; this usually results in an increase in bone mineral density and a reduction in fracture risk. Osteoporosis can be prevented by careful attention to exercise and diet.