Osteoporosis: Trends and intervention

Osteoporosis is a skeletal disorder in which bone strength is compromised due to loss of bone density and bone quality. It is the leading cause of serious morbidity and functional loss in the elderly. At times, it is difficult for the clinician to distinguish between the disease and normal skeletal aging, but advances in the scientific understanding of the underlying disease process have made management of osteoporosis a preventable disease for the most part. Defining the point at which these age-related skeletal changes require intervention presents a major challenge to researchers and clinicians alike. There are several reasons for these difficulties. There is a long period of bone loss before the onset of clinically apparent disease. Also, although current diagnostic procedures can distinguish those at risk of fracture and those not at risk, there is a large overlap in bone density between persons who experience fractures and those who do not. Research efforts directed at these issues have increased dramatically, as have developing technologies in the measurement and screening of bone mineral density. Ongoing advances in the therapeutic modalities have promoted new methods to treat this disorder. This review will describe the mechanisms responsible for osteoporosis and the modalities used to screen and diagnose this common disorder. Various therapeutic approaches now in use, and some promising experimental trials, will be discussed.