Osteoporosis prevention: What patients can do

Osteoporosis prevention requires adequate calcium and vitamin D intake, regular physical activity, and avoidance of smoking and excessive alcohol ingestion. Risk of fracture determines whether medication is also warranted.

A previous vertebral or hip fracture is the most important predictor of fracture risk. Bone density is the best predictor of fracture risk for those without prior adult fractures. Age, weight, certain medications, and family history also help establish a person's risk for osteoporotic fractures.

All women should have a bone density test by the age of 65 or younger (at the time of menopause) if risk factors are present. Guidelines for men are currently in development. Medications include both antiresorptive and anabolic types.

Antiresorptive medications — estrogens, selective estrogen receptor modulators (raloxifene), bisphosphonates (alendronate, risedronate, and ibandronate), and calcitonins — work by reducing rates of bone remodeling. Teriparatide (parathyroid hormone) is the only anabolic agent currently approved for osteoporosis in the United States. It stimulates new bone formation, repairing architectural defects and improving bone density.

All persons who have had osteoporotic vertebral or hip fractures and those with a bone mineral density diagnostic of osteoporosis should receive treatment. In those with a bone mineral density more than the osteoporosis range, treatment may be indicated depending on the number and severity of other risk factors.1

Clinician offices are the best locations for patients to access reading material, videos, and web sites on bone health, effective prevention measures, treatments for osteoporosis, and the importance of adequate calcium throughout the life cycle. The annual examination should be the time when evaluation and identification of patient risk factors for osteoporosis are done and the patient is counseled on the need for adequate calcium, either through diet or supplement, vitamin D, and weight-bearing exercise.

Women depend on their physicians for advice and counseling regarding both prescription and nonprescription interventions and therapies for bone health. The clinician's office should have a comprehensive sampling of educational materials that are of use to patients both for educating them about general preventive health practices as well as for giving them background information that will equip them to ask the physician health questions that directly pertain to them.2

When working with patients, clinicians should solicit patient concerns about trying to increase their calcium intake and barriers that the patient has experienced in the past or may anticipate in the future.3

References

1. Cosman F. The prevention and treatment of osteoporosis: A review. MedGenMed 2005; 7:73.

2. Bachmann G. Calcium compliance: The clinician's role. J Reprod Med 2005; 50(11 Suppl):896-900.

3. Blalock SJ. Toward a better understanding of calcium intake: Behavioral change perspectives. J Reprod Med 2005; 50(11 Suppl):901-906.