Osteoporosis: current approaches and future prospects in diagnosis, pathogenesis, and management.

This review summarizes some of the major advances in our understanding and management of osteoporosis. Bone densitometry is the key to diagnosis but has limitations. Ultrasound and peripheral densitometry may provide new, rapid screening tools. Biochemical markers may provide an assessment of fracture risk as well as the response to therapy. Studies of the genetics of ostoporosis may also provide new approaches to diagnosis. The interactions between local and systemic factors, particularly between estrogen, cytokines, and prostaglandins, have suggested a mechanism for bone loss in rodent models. Nutritional deficits of calcium, vitamin D, and vitamin K may play a role in pathogenesis. Therapy is largely based on fracture prevention with calcium, vitamin D, and exercise programs, coupled with antiresorptive therapy. New approaches involving anabolic agents are under development. Our goal must be to increase our understanding of pathogenesis and to develop new cost-effective therapeutic agents as rapidly as possible so as to prevent an epidemic of osteoporotic fractures throughout the world in the next millennium.