Management of postmenopausal osteoporosis for primary care.
OBJECTIVE
The shift in health care delivery from a subspecialty to primary care system has transferred the responsibility of preventing osteoporotic fractures from specialists in metabolic bone disease to the web of physicians--family practitioners, general internists, pediatricians, and gynecologists--who provide the bulk of primary care. The challenge for this group of physicians is to decrease the rising prevalence of osteoporotic hip and vertebral fractures while operating within the cost parameters. It is the goal of this brief summary to provide primary practitioners with focused guidelines for the management of postmenopausal osteoporosis based on new and exciting developments. Prevention and treatment will change rapidly over the next decade and these advances will require changes in these recommendations.


METHODS
We identified patients at risk for osteoporosis and provided indications for bone mass measurement, criteria for diagnosis of osteoporosis, therapeutic interventions, and biochemical markers of the disease.


RESULTS
Prevention and treatment are discussed, including hormone replacement therapy and use of calcitonin, sodium fluoride, bisphosphonates, and serum estrogen receptor modulators.


CONCLUSIONS
Postmenopausal osteoporosis should no longer be an accepted process of aging. It is both preventable and treatable. Primary care physicians must proactively prevent and treat osteoporosis in their daily practice, and combination therapies are suggested.
University of Colorado Health Sciences Center, Denver, USA.
P
P
Miller
B
B
Lukert
S
S
Broy
R
R
Civitelli
R
R
Fleischmann
R
R
Gagel
S
S
Khosla
M
M
Lucas
M
M
Maricic
R
R
Pacifici
R
R
Recker
H S
HS
Sarran
B
B
Short
M J
MJ
Short
D015502:Absorptiometry, Photon; D015415:Biomarkers; D015519:Bone Density; D002116:Calcitonin / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000819:agonists; D005194:Family Practice; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D010880:Piperidines / Q000627:therapeutic use; D011320:Primary Health Care; D020849:Raloxifene Hydrochloride; D012017:Referral and Consultation; D012307:Risk Factors; D012969:Sodium Fluoride / Q000627:therapeutic use
D015415:Biomarkers; D004164:Diphosphonates; D004967:Estrogens; D010880:Piperidines; D020849:Raloxifene Hydrochloride; D012969:Sodium Fluoride; D002116:Calcitonin