Prevention of bone loss and fractures in women

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Bone loss with aging is very largely a female problem resulting from loss of gonadal function. It is easily and safely preventable by oestrogen-progestogen replacement therapy. This fact is only now finally accepted although these principles were enunciated in a report to the Association of American Physicians by Albright as long ago as 1940 [l]. They were presented by him, in amplified form, to the American Medical Association in 1941 [2] and, together with a rationale for the disease, to the American College of Physicians when he received the Phillips Award in 1947 [3]. Although seriously incapacitated by parkinsonism at that time, Albright clearly thought that this subject was of sufficient clinical importance to warrant presentation before those critical audiences. It is gratifying to note that his views were finally accepted in April 1984 by the Consensus Development Conference on Osteoporosis at the National Institutes of Health [4], whose report is actually in good agreement with that previously presented by the Obstetrics and Gynecology Advisory Committee of the U.S. Food and Drug Administration on 28 July 1977 [5]. In the case of bone loss, the explanation for the slow progress is fairly apparent. Albright’s concepts were based primarily on long and remarkably astute clinical experience and were confirmed by balance studies. Nowadays, at least in American universities, few professors of medicine stay in one place long enough to acquire comparable long-term clinical experience. Furthermore, balance studies are hard to understand without first-hand experience. Fig. 1 illustrates Albright’s original study, in which he showed that 1 mg of stilboestrol reversed the negative calcium and phosphate balance of an osteoporotic woman and that 15 mg put her into positive balance.