Osteoporosis - Its diagnosis, management and treatment with a new oral bisphosphonate agent, etidronate

Osteoporosis is an increasingly widespread and serious disorder, which results in significant long-term morbidity, mortality and negative effects on the quality of life for countless hundreds of thousands of older Canadians. Careful early assessment using bone density measurement is an important diagnostic tool, permitting detection of substantial bone loss and thus identifying those at increased fracture risk. Aggressive management of bone loss and preventive care for those at highest risk is necessary in order to help avoid subsequent fractures and serious resulting sequelae. Conservative treatment, employing exercise programs, an optimal nutritional status and particularly adequate calcium intake, is strongly recommended for post-menopausal women unless otherwise contraindicated. If 25-hydroxyvitamin D levels are decreased, then supplementation with a vitamin D preparation should be seriously considered. Estrogen replacement therapy (ERT) has been shown to be effective in helping to prevent and counteract the effects of osteoporosis in amenorrheic women. If bone loss persists, or in those cases where ERT is not feasible, administration of the new bisphosphonate etidronate should be considered. This agent binds strongly to hydroxy-apatite crystals in the bone, thereby inhibiting bone resorption. Calcitonin may be of some benefit, particularly for those in whom back pain is associated with vertebral fracture. Other therapies such as sodium fluoride and anabolic steroids should be considered for those with ongoing fractures in spite of the use of the above-mentioned therapies.