The most common metabolic bone disorder is osteoporosis, which affects 25 million Americans. It appears to affect men to the same degree as women when the data is corrected for age. The two most important risk factors for osteoporosis are insufficient bone mass at the time of skeletal maturity and rapid loss of bone after menopause. Even with current interventions, it is anticipated that hip fractures will increase three fold by the year 2040. The World Health Organization considers low body weight, recent loss of body weight, history of fragility fractures, history of fractures in the family and a history of smoking to be high positive risk factors for fractures regardless of bone mass.

Diagnosis of osteoporosis is currently done utilizing duel energy x-ray absorptiometry (DXA). There are also ways to determine bone resorption rates and to predict if the patient is at average, above average, or lower than average risk for fragility fracture depending upon weight status, fracture history and history of smoking. The most important principle in the treatment of osteoporosis is prevention. Two critical elements that determine fragility of bone is related to bone mass or the attainment of peak bone mass and the prevention of postmenopausal resorption. The attainment of peak bone mass is dependent on premenopausal intact of calcium, Vitamin E, appropriate caloric intake, normal menstrual status and appropriate exercise program.

If bone loss occurs despite physiological prevention measures, as described above, additional therapeutic agents could be utilized. Different therapeutic agents include anti absorptive agents including hormone replacement such as Estrogen and Tamoxifen. Bisphosphonates and calcitonine could also be utilized. Currently there are bone stimulator agents which are awaiting approval by the FDA. Current recommended daily calcium intact for adults between the ages of twenty-five and sixty-five is 1000 mgs per day for men and 1500 mgs per day for women. Pregnant or nursing mothers should take 1200 mgs to 1500 mgs per day. Postmenopausal women and men and women above the age of sixty-five should take approximately 1500 mgs a day. Exercise is highly effective in favorably affecting the skeleton and preventing falls.

A moderate level of exercise by an individual who receives an appropriate diet with adequate calcium and Vitamin D intake significantly diminish great risk of fractures. It is recommended that an individual adopt an exercise program which includes three components. The program should include impact exercises such as jogging, brisk walking and stair-climbing. Strengthening exercises which utilize light weight in a comprehensive program. Care should be taken to avoid excessive sit-ups and lifting objects from a flexed position which can actually increase potential vertebral compression fractures. The third component for a comprehensive exercise program should include balance training.

An individual with the above mentioned risk factors, individuals over the age of sixty-five, or postmenopausal women should engage in appropriate dietary and exercise program. A DXA exam is a good screening tool, especially if an individual has the risk factors mentioned above. If, in light of reducing risk factors and engaging in appropriate diet and exercise, an individual continues to sustain bone loss, supplementary agents should be utilized.