Summary

The availability of therapies documented to prevent bone loss and to reduce fracture risk poses new questions and challenges for clinicians and planners of health policy, including how to select among the various options, whether to use them in combination, and how long they should be used. The most immediate questions, however, are which patients should receive these therapies and how can we best identify these patients? The purpose of managing patients with or at risk for osteoporosis is to reduce the likelihood of fracture, the only consequence of this disorder that affects a patient′s life expectancy, physical function, quality of life, and health care costs. Lifestyle changes such as nutrition, exercise, and avoidance of smoking may slow bone loss. Vitamin D supplements and exercise interventions decrease the frequency of falls in older adults. Supplements of calcium and vitamin D, hip protectors, and bone-strengthening pharmaceutical agents reduce the risk of fracture in certain clinical situations. The indications for these various interventions and both the need for and type of “screening” needed before deciding to intervene differ substantially since the treatments address different risk factors in different populations of patients. Comprehensive discussions about the roles of calcium and vitamin D nutrition, physical activity and exercise, fall prevention strategies, and experience with the use of hip protectors are found elsewhere in this textbook. This discussion focuses on which postmenopausal women should receive pharmacological therapy and strategies to identify these patients because this is where the bulk of evidence exists on which to make recommendations.