Strategies for prevention and treatment of osteoporosis at the primary, secondary, and tertiary level in Leuven, Belgium.

Abstract

The first strategy to prevent osteoporosis is to detect patients at risk for osteoporosis in time before fracture occurs. The known risk factors for osteoporosis can be divided according to modifiable or not modifiable, and according to vertebral or proximal femur fracture site. The importance of accumulation of several risk factor for the incidence of fragility fractures in the population is stressed. Preventive and curative therapy for osteoporosis is possible in all phases of life. Even a recent fracture should be treated, it is never too late to prevent further fractures. Strategies are proposed for the building up period of the skeleton in the adolescence (primary prevention) , for the period when accelerated bone loss starts, as in the perimenopause, during immobilisation and corticosteroid use (secondary prevention) ;and finally at the time of bone loss or fracture (tertiary prevention) . For each of these periods, general and specific therapies are listed. An algorithm for "case finding" and consequent management in clinical practice are discussed as a problem-solving and clinical reasoning exercise. A plea is made for an individualised intervention because preventive and curative treatment for osteoporosis is a long-term treatment and thus an important decision. This decision should be based on cost/benefit, pathophysiology of the case and bone active drugs. If available, it is advisable to share responsibility with an expert in the field, this will improve compliance and outcome.