3-17 THE OSTEOPOROSIS REVOLUTION
This article reviews genetics, local factors, bone density, biochemical bone markers, prevention, and therapy. I abstracted a few points:
The FDA has approved alendronate (Fosamax) and nasal calcitonin for treatment of osteoporosis. Some are concerned that these new agents will unduly reduce the use of estrogen, which should remain the mainstay for prevention of bone loss and fractures in post menopausal women. No trials have directly compared the efficacy of the new antiresorptive agents with estrogen. We do not know whether combination therapy with an antiresorptive agent plus estrogen is effective.
Low bone density predicts fractures better than elevated cholesterol predicts myocardial infarction.
The WHO has recommended that "osteoporosis" be diagnosed when bone mineral density is at least 2.5 SDS below the mean for young adults. A range between (1.0 SD and 2.5 SD) is defined as low bone mass or osteopenia. A range of ±1.0 SD is normal. The value for young adults, rather than age-matched control, is used because a large proportion of older persons are, in fact, osteoporotic.
Because bone density is a continuous measure of risk for fracture, the chosen cutoffs are obviously arbitrary. (The same exists for measurement of blood pressure and cholesterol. RTJ )
Current data indicates that alendronate is appropriate therapy for post-menopausal women with established osteoporosis who cannot or will not take estrogen.
In post menopausal women, hormone replacement therapy with estrogen is highly effective in preventing bone loss and reducing the incidence of fractures—even in older women who are many years past menopause.
Annals Int. Med. March 15, 1997; 126: 458-62 " Perspective"— narrative review from Univ. Of Connecticut Health Center, Farmington

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