Prevention of osteoporosis

Prevention is the only cost-effective approach to osteoporosis and this should be initiated in childhood and applied throughout lifetime. None of the available treatment modalities is effective in restoration of the skeleton once osteoporosis has occurred. The prevention of bone loss is therefore more important than treatment.

That the risk of osteoporosis can be substantially reduced either by increasing peak bone mass or by decreasing the rate of subsequent bone loss is well established. The corner stones of prevention are therefore maximization of peak bone mass in early adulthood and prevention of the rapid bone loss that occurs with the menopause. An adequate calcium intake, moderate exercise and a healthy lifestyle (avoidance of smoking and excessive alcohol) are essential for maximization of bone mass. Oestrogen therapy protects against the accelerated bone loss in the early postmenopausal years whereas later in life oestrogen, calcium and vitamin D supplementations reduce the incidence of fracture.

Preventive measures advisable for women of any age are: exercise (but not excessive) to stimulate new bone formation, adequate calcium intake to mineralize the newly formed osteoid tissue and an oestrogen-replete state (endogenous or exogenous). Low body weight (associated with either anorexia nervosa or obsessional exercise) with oestrogen deficient amenorrhoea should be adequately treated whatever the age. Important risk factors such as immobility, smoking, alcohol, excess caffeine should be avoided.