Primary prevention

Primary prevention begins with achieving adequate peak bone mass. Thereafter, primary prevention depends on minimising loss of bone mass and maintaining skeletal micro-architecture, such as trabeculae and cortical thickness.[3]

Education

Evidence from systematic reviews suggests that patient education may be an effective method of improving knowledge and attitudes towards osteoporosis, and improving some health-related behaviours for bone health such as sufficient dairy calcium intake and physical function, but no increase was seen in patients implementing a regular exercise programme.[55][56]​​ 

Exercise

The American College of Obstetrics and Gynecology recommends routine aerobic and weight-bearing exercises to maintain bone health and prevent bone loss.[31]

One systematic review concluded that physical activity plays a role in the prevention of osteoporosis in people aged 65 years and older, improving bone mineral density (BMD) of the lumbar spine and, to a lesser degree, the hip. Activities involving multiple exercises and resistance exercises were found to be more effective.[57]​ 

Diet supplements

Diet supplementation with calcium and vitamin D is a preventative measure aimed at preventing osteoporosis and reducing the incidence of fracture.[31]​ The US Preventive Services Task Force guideline and randomised controlled trial evidence report that there is insufficient evidence to assess the balance of benefits and harms of vitamin D and calcium supplements, alone or in combination, for the primary prevention of fractures in asymptomatic men, premenopausal women, or postmenopausal women who do not live in a nursing home or other institutional care setting.[58][59]​​​​ One Cochrane review concluded that isolated or combined calcium and vitamin D supplementation does not improve BMD in healthy premenopausal women, and therefore is unlikely to help prevent fractures.[60]​ Vitamin D supplementation has been shown to be ineffective at reducing the risk of fracture in the healthy midlife or older population compared with placebo.[61] However, the Bone Health and Osteoporosis Foundation (BHOF) advises a diet that includes adequate amounts of calcium (1000 mg/day for men aged 50-70 years; 1200 mg/day for women aged 51 years and older and men aged 71 years and older) and vitamin D (800-1000 international units/day for men and women older than 50 years), incorporating dietary supplements if dietary intake is insufficient.[62] ​The BHOF suggests that higher doses may be necessary in some adults, such as those with malabsorption.[62] There is evidence that demonstrates that dairy products can increase BMD in healthy postmenopausal women.[63]

Raloxifene

Raloxifene is associated with a significant increase in BMD in postmenopausal women with osteopenia whose BMD T-scores are between -2.5 and -2.0, compared with placebo.[64] Decisions regarding the use of raloxifene as primary prevention for individual women must weigh the risks of venous thrombosis and stroke against potential benefits of reduced risk of vertebral fracture and oestrogen receptor-positive breast cancer.

Glucocorticoid-induced osteoporosis

Bone fracture occurs in 30% to 50% of patients receiving chronic corticosteroid treatment.[65] Glucocorticoid-induced osteoporosis is a complex disorder that encompasses both increased bone resorption and defective bone formation. The bisphosphonates alendronic acid and risedronate have been shown to effectively reduce bone fracture in this population. [ Cochrane Clinical Answers logo ] [Evidence A]​​ Their use should be considered for all patients with corticosteroid treatment continuing beyond 3 months, receiving from 2.5 to ≥7.5 mg prednisolone per day, and in those with a history of prior fracture.[24]​​[66]

In addition, adequate amounts of calcium and vitamin D should be given to improve intestinal calcium absorption.[24]​​

Secondary prevention

Patients with osteoporosis, regardless of prior fracture history, should be assessed for fall risk before discharge and advised of targeted interventions to reduce their specific risks for falling.

Hip protectors have not been found to be helpful in preventing falls in patients in long-term care facilities.[215]

Physical or occupational therapy may be prescribed if impaired gait or weakness is present.

Weight-bearing and balance-promoting exercises are recommended.

Maintaining calcium and vitamin D supplementation is recommended. NIH: calcium and vitamin D - important at every age Opens in new window

Counselling and treatment for smoking cessation and cessation of excessive alcohol use should be provided.

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