Screening for a healthy future

Abstract

Osteoporosis is a serious problem associated with fractures in up to one in two women over the age of 50 and the costs of the fractures to the UK exchequer are over £1.7 billion per annum. Preventing osteoporosis therefore is a significant challenge and could be highly cost-effective. While there are some lifestyle determinants of osteoporosis as defined by bone mineral density (BMD), as yet few interventional studies have shown substantial improvements in BMD by changing lifestyle. Exercise may have a role at specific bone sites, but maintaining improvement over a long time frame may be problematic. Similarly, while there are dietary factors associated with low BMD, with the exception of calcium and vitamin D there is a lack of data showing significant improvements in BMD after alterations in dietary habits. It is therefore valuable to consider pharmaceutical approaches to prevention and up until recently hormone replacement therapy (HRT) was the mainstay of such intervention. The recent concern about the adverse effects of long-term HRT have significantly affected its use for this indication. While alternative treatment, such as bisphosphonates, may be effective in maintaining bone density, their use may well be restricted in the UK by the National Institute for Health and Clinical Excellence, and will in part depend on the absolute risk of fracture. The World Health Organization will shortly release a 10-year fracture risk assessment tool, and this is likely to prove useful to clinicians in determining which individuals are at highest risk of osteoporotic fractures, who, even in the immediate postmenopausal time frame, will benefit from cost-effective intervention.