BEST PRACTICE

Osteoporosis

S P Tuck¹, R M Francis²

¹ Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne
² University of Newcastle upon Tyne and Freeman Hospital, Newcastle upon Tyne.

Correspondence to:
Dr R M Francis, Musculoskeletal Unit, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK;
RMFrancis{at}compuserve.com

Osteoporosis is characterised by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and consequent increase in fracture risk. It is a common condition affecting one in three women and one in 12 men, resulting in substantial morbidity, excess mortality, and health and social services expenditure. It is therefore important to develop strategies to prevent and treat osteoporosis in both men and women. This paper reviews the pathogenesis of primary and secondary osteoporosis, as well as diagnosis, investigation, and management. This should include lifestyle changes to reduce bone loss and decrease the risk of falls, the identification and treatment of secondary causes of bone loss, and specific treatment for osteoporosis. Hormone replacement therapy, raloxifene, bisphosphonates, calcium and vitamin D, calcitonin, and parathyroid hormone have all been shown to improve bone density and decrease the risk of fracture in specific situations. It is important that treatment is tailored to the individual patient, to ensure compliance and optimise the potential benefits.

Keywords: osteoporosis; bone mineral density

Abbreviations: BMD, bone mineral density; HRT, hormone replacement therapy; IGF-1, insulin-like growth factor 1; 25-OHD, 25-hydroxyvitamin D; rhPTH, recombinant human parathyroid hormone; WHO, World Health Organisation

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