Feature Article

An update on osteoporosis

Feature Article

An update on osteoporosis

Roderick Clifton-Bligh, Philip N Sambrook

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Abstract

Simple strategies for the prevention of osteoporosis continue to be underutilised, and a fitter elderly population with higher individual bone mineral density could potentially reduce the incidence of morbidity due to osteoporosis.

Key Points

  • Assessment of bone mineral density (BMD) by dual energy x-ray absorbtiometry (DXA) remains the gold standard for diagnosis of osteoporosis.
  • General lifestyle measures in the prevention and management of osteoporosis include adequate calcium intake, regular weight-bearing exercise and avoidance of smoking and excess alcohol intake.
  • Patients with a previous minimal trauma fracture should receive potent antiresorptive therapy to prevent further fracture.
  • In the absence of fracture, treatment decisions should be based on the severity of osteopenia and the presence of other risk factors including age, gender, family history and risk of falls.
  • The oral bisphosphonates alendronate and risedronate and the selective oestrogen receptor modulator raloxifene increase BMD and reduce fractures in osteoporotic patients.
  • Hormone replacement therapy (HRT) increases BMD but its effect on fracture prevention is less clear. Calcitriol is no longer recommended as first line treatment of osteoporosis.