Osteoporosis: pathogenesis, diagnosis, prevention and management.
Osteoporosis has emerged as a major and increasing health problem requiring interventions at both the individual and community levels. Most cases of osteoporosis are found among women after the menopause, since menopausal status and age are key predictors of fracture risk. This review has focused particularly on osteoporosis occurring in postmenopausal women: the magnitude of the problem, how it occurs, how it is diagnosed, strategies in prevention and treatment. The diagnosis of osteoporosis and identification of individuals with heightened fracture risk due to osteopenia have been greatly facilitated by the development of dual energy X-ray absorptiometry, a simple, safe, highly precise technique for bone density measurement. Where possible, intervention strategies in osteoporosis have been related to what is known about the pathogenesis of bone loss, especially the management of modifiable risk factors. Oestrogen deficiency of any cause results in accelerated bone turnover, with an increase in the rate of net bone loss. Exogenous oestrogens can control this form of bone loss. In established osteoporosis, hormone replacement therapy can achieve clinically-significant gains in bone mass. Consideration of hormone replacement therapy is pivotal in preventive and therapeutic strategies. Issues other than osteoporosis must be taken into account when hormone replacement is considered. Attention to other modifiable risk factors, both in the lifestyle and of a medical nature, is also indicated. A number of promising agents for the treatment of established osteoporosis are described. However, available data on fracture prevention by these agents are limited. There is concern that an ideal therapy for established osteoporosis may not be achievable. Therefore, strong emphasis is placed on the need for osteoporosis prevention now and in the foreseeable future. Although much has been learnt in recent years, more research is needed in the long-term prediction of fracture risk, broadly-applicable measures to reduce the prevalence of osteoporosis, and targeted interventions for individuals at high risk.
Wark
J D
JD
D015519:Bone Density / Q000502:physiology; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy