Progress in Osteoporosis and Fracture Prevention: Focus on Postmenopausal Women

Kenneth G Saag; Piet Geusens


Arthritis Res Ther. 2009;11(5):251 

In This Article

Abstract and Introduction


In the past decade, we have witnessed a revolution in osteoporosis diagnosis and therapeutics. This includes enhanced understanding of basic bone biology, recognizing the severe consequences of fractures in terms of morbidity and short-term re-fracture and mortality risk and case finding based on clinical risks, bone mineral density, new imaging approaches, and contributors to secondary osteoporosis. Medical interventions that reduce fracture risk include sufficient calcium and vitamin D together with a wide spectrum of drug therapies (with antiresorptive, anabolic, or mixed effects). Emerging therapeutic options that target molecules of bone metabolism indicate that the next decade should offer even greater promise for further improving our diagnostic and treatment approaches.


In the past decade, we have witnessed a revolution in understanding bone biology. Major progress has also been achieved in fracture risk estimation and prevention of fractures. How does this progress translate into daily clinical practice? First, case finding of subjects at highest risk for fractures is now possible at the individual patient level, using clinical bone- and fall-related risk factors, with and without bone mineral density (BMD). Second, prevention of vertebral and nonvertebral fractures, including hip fractures, is now possible by optimizing calcium homeostasis and by appropriate medication in well-selected patients with a high risk of fracture. Recent studies indicate new possibilities for case finding, such as in vivo structural analysis of bone microarchitecture, and new molecular targets to rebalance bone remodeling. Here, we review recent progress in case-finding strategies and in the evidence that the risk of first and subsequent fractures can be prevented in daily clinical practice.


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