Prevention of Osteoporosis and Management of Menopause with Hormone Replacement Therapy

Abstract Prevention of osteoporosis means prevention of low bone mass. Since bone mass at any age, at least until the age of 75, depends largely on the peak bone mass obtained at age 25, prevention should focus on anything that can increase peak bone mass. The problem is that the major determinants of peak bone mass are unchangeable, and the value of factors such as nutrition and exercise is uncertain. Even if we could identify, at the age of 13 or earlier, girls who are destined to become osteoporotic and those who will fracture, we probably could not persuade them to change their lifestyle or accept a therapy to prevent a disease from occurring 50 years later. Also, although we believe that lifestyle factors are important in determining bone mass and rates of osteoporotic fractures, we are not sure that lifestyle changes will prevent osteoporosis. For these reasons and others, prevention is focused on preventing the bone loss that occurs with menopause, when osteoporosis is diagnosed, or when an individual becomes inactive and risks developing osteoporosis. Most of the interventions involve hormones.