Prevention of Osteoporotic Fractures

Abstract

Low-trauma fractures associated with osteoporosis or low bone mineral density are a major public health concern with considerable consequences in terms of morbidity, mortality and utilization of healthcare resources. Fractures occur when the force applied to bone exceeds its strength. Reduction of fracture risk can be accomplished by increasing bone strength and preventing falls. Bone mineral density, a major component of bone strength, is determined by peak bone mass and the subsequent rate of bone loss. The genetic potential for achieving maximum peak bone mass can be enhanced by weight-bearing physical activities and sufficiency of calcium and vitamin D during childhood and adolescence. The same lifestyle measures may reduce the rate of bone loss later in life and allow full expression of the beneficial effects of pharmacological interventions. Calcium and vitamin D have been shown to reduce fracture risk in some high-risk populations. Oral, nasal and parenteral pharmacological agents to reduce fracture risk are widely available. Avoidance of lifestyle factors that are detrimental to skeletal health, such as cigarette smoking and excess alcohol consumption, are key components of any program to decrease fracture risk. Muscle strengthening, balance training and vitamin D replacement can reduce falls.