Putting osteoporosis in perspective.

Osteoporosis is characterized by a reduction in bone mineral density (BMD). Dietary patterns that encourage adequate calcium intake are essential to maximal development and later maintenance of bone mass. The majority of white women are at risk for osteoporosis-related fractures, especially in the wrist, spine, and hip. The degree of fracture risk at a specific bone site is best assessed by measuring BMD with single- or x-ray-photon absorptiometry. BMD in adults of any age is quite variable. Numerous diet and lifestyle factors influence BMD and, in turn, fracture risk. Sufficient evidence exists for a relationship between BMD and diet, particularly calcium and vitamin D; amenorrhea; body weight; alcoholism; smoking; and physical inactivity. Less convincing evidence exists for a relationship with dietary protein, dietary phosphorus, and caffeine intake. To minimize fracture risk, young women should have regular menses, consume a nutritionally adequate diet (according to the principles of the Food Guide Pyramid), perform regular physical activity, only consume a moderate intake of alcohol (if any), and not smoke. Postmenopausal women should follow those same guidelines and should seriously consider estrogen replacement therapy. Elderly persons especially should ensure adequate calcium and vitamin D nutriture. Currently, osteoporosis is the rule, rather than the exception, in old age for many white women. Dietitians can help reduce the prevalence of this disorder.