Osteoporosis: Key Issues in Management

Osteoporosis is a disease characterized by low bone mass with micro architectural deterioration of bone tissue leading to enhance bone fragility. This increases the susceptibility to fracture. Osteoporosis is a major public health problem. Hip fractures are the most devastating consequence of osteoporosis. Osteoporosis is essentially an asymptomatic disease. Medical evaluation includes complete history and examination to identity risk factors, secondary causes of osteoporosis, and secondary complications of fractures. Low bone mass can only be diagnosed by measuring bone mineral density (BMD) by various techniques of which the gold standard is DEXA. Current management strategies include nonpharmacological measures like regular exercise, Calcium and vitamin D rich healthy diet, abstinence from smoking and prevention of falls. Pharmacological measures include Anticatabolic drugs like Bisphosphonates (Alendronate, Risedronate, Zoledronate). SERMs. Estrogen, Calcitonin, and anabolic drugs like Teriparatide, and Strontium. Correction of metabolic abnormalities by judicious use of calcium and vitamin D is desirable before initiating specific drug treatment. Ralixifene, Estrogen and Strontium are used in mild osteoporosis, Bisphosphonates are recommended in moderate to severe osteoporosis and Teriparatide use is indicated in severe osteoporosis with fractures. Calcitonin is used as adjuvant especially for its adjuvant effect.