Management of osteoporosis.

Osteoporosis is clearly more easily prevented than treated. Prevention should start early for those thought to be most at risk. However, for the majority, menopause is the most convenient time point at which to evaluate the necessity for prevention. While oestrogens are the most effective therapeutic agent for prevention of postmenopausal bone loss, they must be used judiciously with attention to reduction in other nutritional and lifestyle risk factors. When given to women with an intact uterus, oestrogen prescription currently should be accompanied by progestogens, several of which may also reduce bone loss. All individuals should be encouraged to obtain an adequate calcium intake (100-1500 mg day-1) and to continue an active lifestyle. Therapy of the clinically overt disorder follows similar guidelines, with therapeutic options including calcitonin androgens and diphosphonates as well as oestrogens as antiresorptive agents. Methods of stimulating new bone formation are limited, the best documented effects being those of fluoride. However, care must be taken in its use and efficacy has yet to be finally established. Other modalities are as yet experimental. Much can be gained by careful attention to the general health of the patients and their environment, since reduction in risk of falls, and thus fracture, is at least as important as attempts to modify the skeleton.