Osteoporosis: drug and nondrug therapies for the patient at risk.

Preventing bone loss and avoiding fractures are the most effective therapies for osteoporosis. Nondrug measures include weight-bearing exercise, adequate calcium intake, and the prevention of falls. Estrogen replacement therapy can protect bone from rapid demineralization typical of the early post-menopausal period. New research has provided more data on estrogen's safety and efficacy. Calcitonin is an option when estrogen is contraindicated. Although calcitonin requires frequent injections, it does provide some analgesic effect for patients with osteoporosis-related fracture. Fluoride and etidronate have shown promise but remain investigational due to questions about long-term effects on bone mass. Potent third-generation bisphosphonates are being studied and may be available soon.