The clinician’s guide to prevention and treatment of osteoporosis
Read full paper →- Authors
- Meryl S. LeBoff, S. L. Greenspan, Karl Insogna, E. Michael Lewiecki, Kenneth G. Saag, Andrea Singer, Ethel S. Siris
- Journal
- Osteoporosis International
- Year
- 2022
- Citations
- 1,284
TL;DR
This comprehensive guide synthesizes evidence and expert opinion to provide actionable recommendations for preventing, diagnosing, and treating osteoporosis in adults aged 50 and older, emphasizing that lifestyle interventions (calcium, vitamin D, exercise, fall prevention) are foundational, and effective medications can dramatically reduce fracture risk, which is crucial for anyone looking to understand and manage their personal bone health.
What they tested
This paper is a consensus statement and clinical guideline, not a single experimental study. Therefore, it did not "test" interventions in the traditional sense. Instead, it reviewed and synthesized existing scientific evidence and expert clinical experience to provide recommendations on various approaches to osteoporosis management.
The interventions and strategies covered by the guidelines, which are based on evidence from other studies, include:
**Dietary and Nutritional Interventions:**
* Adequate total calcium intake (from diet and supplements).
* Monitoring and maintaining sufficient serum 25-hydroxyvitamin D levels, often requiring supplementation.
**Lifestyle Modifications:**
* Smoking cessation.
* Avoidance of excessive alcohol intake.
* Engagement in weight-bearing and resistance-training exercise.
* Implementation of fall prevention strategies (e.g., addressing sedating medications, polypharmacy, hypotension, gait/vision disorders, home hazard evaluation).
* Instruction on balance training and safe movement strategies.
**Pharmacologic Interventions:**
* **Antiresorptive agents** (reduce bone breakdown): Bisphosphonates (alendronate, ibandronate, risedronate, zoledronic acid), estrogen-related therapy (ET/HT, raloxifene conjugated estrogens/bazedoxifene), RANK-ligand inhibitor (denosumab), calcitonin salmon.
* **Anabolic agents** (build new bone): Parathyroid hormone analogs (teriparatide, abaloparatide), sclerostin inhibitor (romosozumab).
**Diagnostic and Monitoring Strategies:**
* Bone Mineral Density (BMD) testing using Dual-energy X-ray Absorptiometry (DXA).
* Vertebral fracture imaging (X-ray or DXA vertebral fracture assessment).
* Annual height measurement.
* Assessment of fracture risk using tools like the US-adapted FRAX® model.
* Measurement of serum 25-hydroxyvitamin D levels.
* Selective measurement of bone turnover markers.
* Investigation of secondary causes of bone loss.
The primary outcome measures that these interventions aim to influence, as discussed in the guide, are:
**Fracture Prevention:** Reduction in the incidence of osteoporotic fractures, including hip, vertebral (clinical and subclinical), forearm, and proximal humerus fractures.
**Bone Mineral Density (BMD