1. Maturitas. 1996 Mar;23(2):193-207.

Osteoporotic fractures: background and prevention strategies.

Wark JD.

University of Melbourne, Department of Medicine, Royal Melbourne Hospital
Victoria, Australia.

OBJECTIVES: To review current knowledge of the epidemiology, pathogenesis,
prevention and treatment of osteoporosis, with particular reference to issues
related to the menopause.
METHODS: Peer-reviewed publications were assessed.
RESULTS: Much international variation exists in the prevalence of osteoporosis
and the incidence of fracture. Risk fractures for osteoporosis are numerous. The 
menopause and other causes of hypogonadism in both women and men strongly
predispose to osteoporosis. Various endocrinopathies, especially glucocorticoid
excess, also are important. The contribution of family history may be explained
by one or more genetic markers. Poor vitamin D and calcium nutrition, smoking,
high alcohol consumption and inactivity increase risk. Reduced bone mass is a
major risk factor for fracture, although the magnitude of that risk may vary
between populations. In addition, bone fragility, length of the femoral neck (for
hip fracture), history of prior fracture (for vertebral fracture) and falls
affect fracture risk. Useful methods for measuring bone density are available for
both epidemiologic surveillance and for clinical practice. Dual energy x-ray
absorptiometry is the most desirable method in clinical care settings. Some risk 
factors can be modified for prevention of osteoporosis. Postmenopausal bone loss 
can be inhibited with estrogen or estrogen plus progestin therapy. Bone loss in
the elderly may be moderated with calcium and vitamin D supplementation.
Maintenance of muscle tone and strength through exercise may reduce falls.
CONCLUSIONS. Osteoporosis is a large and growing health problem in many
countries. Prevention of osteoporosis is a high priority, especially because
treatment of the established disease remains sub-optimal. Prevention requires
immediate, intermediate-term and long-term strategies. First line therapy for
established osteoporosis in women in many countries is estrogen or estrogen plus 
progestin, calcium and vitamin D. Prospects for improved prevention of
osteoporotic fractures are encouraging.


PMID: 8735357  [PubMed - indexed for MEDLINE]