Primary prevention
Patients at risk of osteoporosis should be screened and started on appropriate therapy. See Osteoporotic spinal compression fractures.
In the UK, bisphosphonates are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of osteoporosis.[41] When bisphosphonates are not tolerated or contraindicated, NICE recommends denosumab for primary prevention.[42] NICE guidance assumes that women who receive treatment have an adequate calcium intake and are vitamin D replete. If the latter is not the case, calcium and/or vitamin D supplementation should be considered.
Food and Drug Administration-approved pharmacological options for the prevention and/or treatment of postmenopausal osteoporosis in the US include:[43]
Bisphosphonates
Calcitonin (however, this is infrequently used and is considered second-line therapy reserved for women in whom alternative treatments are not suitable)[43]
Oestrogen-related therapy (oestrogen and/or hormone therapy, raloxifene, conjugated oestrogens/bazedoxifene)
Parathyroid hormone analogues (teriparatide, abaloparatide)
Denosumab
Romosozumab
Patients with osteoporosis should also be assessed for falls risk, with appropriate physiotherapy or occupational therapy if impaired gait or weakness is present.[43]
Other preventive measures include:
Wearing seat belts and helmets
Observing speed limits
Not using mobile phones while driving
Not driving under the influence of alcohol or drugs
Daily exercise (increases bony mass and prevents fractures)
Good nutrition
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