The prevention of osteoporosis is made up of general lifestyle preferences and other more specific treatments. Regular and frequent activity of reasonable intensity is recommended and very helpful at all ages.  No one seems to know just how exercise is too much or too little, but most physicians recommend about 30 minutes of vigorous exercise about 3 to 5 times per week.  During the growing years of adolescence and teen years, attention must be paid to dietary calcium if peak bone mass is to be achieved.   Specific attention to dietary calcium intake may also be warranted beyond age 60 which may come in the form of increased food calcium or from specific calcium and vitamin D supplements.  For women at menopause, the appropriate administration of estrogen (or some of the new synthetic estrogens) is the most potent means by which bone mass may be preserved, thereby preventing fractures in the future.  In fact, correction of low reproductive hormone levels at any age is important if proper bone mass is to be maintained.

There is no one treatment, or combination of treatments which can guarantee zero risk of fractures due to osteoporosis.  The best prevention, however, is a life-long commitment to physical activity, good nutrition, and normal reproductive hormone status.

Treatment of Osteoporosis

A number of experts designate patients which have had a non-traumatic fracture of the spine, forearm, or hip as "established osteoporosis".  This designation avoids the question of whether the bone mineral density (BMD) is greater than 2.5 standard deviations below average BMD required for the W.H.O. definition of osteoporosis (see definition of osteoporosis page).  The point is this: patients with proven osteoporosis (by fracture history or BMD > 2.5 SD below average) generally need some for of specific drug therapy.  All patients, osteoporosis and osteopenia, need the lifestyle and dietary therapies discussed above.

Drugs Which Have Been Established as Treatments for Osteoporosis

Drugs which are used to treat osteoporosis can be grouped into two groups.   The first category is comprised of agents which limit the rate of bone loss.   These drugs decrease the rate at which osteoclasts reabsorb bone (see page on bone remodeling in adults) and are referred to as "anti-resorption drugs".

Calcium and Vitamin D  |  Estrogen  |  Designer Estrogens   |  Calcitonin  |  Biophosphonates   

The second group of osteoporosis drugs promote bone formation and are referred to as "bone forming drugs".  At the present time, only anti-resorbers are approved in the United States by the FDA for use in treating osteoporosis and none of the drugs in this group have proven themselves yet.