Osteoporosis pp 275-285 | Cite as

Prevention of Osteoporosis

Making Sense of the Published Evidence
  • Peter S. Millard
Part of the Current Clinical Practice book series (CCP)

Abstract

In this chapter, we will discuss the complexities of applying osteoporosis research findings to clinical practice, review the evidence for some specific preventive interventions, and suggest an algorithm that primary care providers can use to help make decisions about screening for osteoporosis and the prevention of fractures.

Keywords

Cholesterol Estrogen Osteoporosis Corticosteroid Stratification 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jacobs HS, Loeffler FE. Postmenopausal hormone replacement therapy. BMJ 1992; 305: 1403–1408.PubMedCrossRefGoogle Scholar
  2. 2.
    Bauer DC, Browner WS, Cauley JA, et al. Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group. Ann Intern Med 1993; 118: 657–665.PubMedGoogle Scholar
  3. 3.
    Rothman KJ. Modern Epidemiology. Boston: Little, Brown and Company, 1986.Google Scholar
  4. 4.
    Barrett-Connor E. Postmenopausal estrogen and prevention bias. Ann Intern Med 1991; 115: 455–456.PubMedGoogle Scholar
  5. 5.
    Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results valid? JAMA 1993; 270: 2598–2601.PubMedCrossRefGoogle Scholar
  6. 6.
    Rose G. The Strategy of Preventive Medicine. New York: Oxford University Press, 1994.Google Scholar
  7. 7.
    Cooper C, Barker DJP. Risk factors for hip fracture. NEngl JMed 1995; 332: 815–816.CrossRefGoogle Scholar
  8. 8.
    Chow R, Harrison JE, Notarius C. Effect of two randomised exercise programmes on bone mass of healthy postmenopausal women. BMJ 1987; 295: 1441–1444.PubMedCrossRefGoogle Scholar
  9. 9.
    Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ. Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 1988; 108: 824–828.PubMedGoogle Scholar
  10. 10.
    Zylstra S, Hopkins A, Erk M, Hreshchyshyn MA, Anbar M. Effect of physical activity on lumbar spine and femoral neck bone densities. Int J Sports Med 1989; 10: 181–186.PubMedCrossRefGoogle Scholar
  11. 11.
    Nelson M, Fisher E, Dilmanian F, Dallai G, Evans WJ. A 1-y walking program and increased dietary calcium in postmenopausal women: effects on bone. Am J Clin Nutr 1991; 53: 1304–1311.PubMedGoogle Scholar
  12. 12.
    Krall EA, Dawson-Hughes B. Walking is related to bone density and rates of bone loss. Am JMed 1994; 96: 20–26.Google Scholar
  13. 13.
    Cavanaugh DJ, Cann CE. Brisk walking does not stop bone loss in postmenopausal women. Bone 1988; 9: 201–204.PubMedCrossRefGoogle Scholar
  14. 14.
    Prince RL, Smith M, Dick IM, et al. Prevention of postmenopausal osteoporosis: a comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med 1991; 325: 1189–1195.PubMedCrossRefGoogle Scholar
  15. 15.
    Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fractures in white women. NEngl JMed 1995; 332: 767–773.CrossRefGoogle Scholar
  16. 16.
    Notelovitz M, Martin D, Tesar R, et al. Estrogen therapy and variable-resistance weight training increase bone mineral in surgically menopausal women. J Bone Miner Res 1991; 6: 583–590.PubMedCrossRefGoogle Scholar
  17. 17.
    Nelson ME, Fiatrone MA, Morganti CM, Trice I, Greenberg RA, Evans WJ. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. JAMA 1994; 272: 1909–1914.PubMedCrossRefGoogle Scholar
  18. 18.
    Nevitt MC, Cummings SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA 1989; 261: 2663–2668.PubMedCrossRefGoogle Scholar
  19. 19.
    Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. NEngl JMed 1994; 331: 821–827.CrossRefGoogle Scholar
  20. 20.
    Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The study of osteoporotic fractures research group. Lancet 1993; 341: 72–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Gordon M, Huang J. Monograph series on aging-related diseases: VI. Osteoporosis. Chron Dis Canada 1995; 16: 1–23.Google Scholar
  22. 22.
    Ettinger B, Grady D. The waning effect of postmenopausal estrogen therapy on osteoporosis. N Engl J Med 1993; 329: 1192–1193.PubMedCrossRefGoogle Scholar
  23. 23.
    Felson DT, Zhang Y, Hannan MT, Kiel DP, Wilson PWF, Anderson JJ. The effect of postmenopausal estrogen therapy on bone density in elderly women. NEngl JMed 1993; 329: 1141–1146.CrossRefGoogle Scholar
  24. 24.
    Cauley JA, Seeley DG, Ensrud K, Ettinger B, Black D, Cummings SR. Estrogen replacement therapy and fractures in older women. Study of osteoporotic fractures research group. Ann Int Med 1995; 122: 9–16.PubMedGoogle Scholar
  25. 25.
    Gorsky RD, Koplan JP, Peterson HB, Thacker SB. Relative risks and benefits of long-term estrogen replacement therapy: a decision analysis. Obstet Gynecol 1994; 83: 161–166.PubMedGoogle Scholar
  26. 26.
    Healy B. PEPI in perspective: good answers spawn pressing questions. JAMA 1995; 273: 240–241.PubMedCrossRefGoogle Scholar
  27. 27.
    Adami HO, Persson I. Hormone replacement and breast cancer: a remaining controversy? JAMA 1995; 274: 178–179.PubMedCrossRefGoogle Scholar
  28. 28.
    Colditz GA, Hankinson SE, Hunter DJ, et al. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl JMed 1995; 332: 1589–1593.CrossRefGoogle Scholar
  29. 29.
    Steinberg KK, Thacker SB, Smith SJ, et al. A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer. JAMA 1991; 265: 1985–1990.PubMedCrossRefGoogle Scholar
  30. 30.
    Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Int Med 1992; 117: 1016–1037.PubMedGoogle Scholar
  31. 31.
    The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. JAMA 1995; 273: 199–208.CrossRefGoogle Scholar
  32. 32.
    Sartoris DJ, Resnicj D. Dual-energy radiographic absorptiometry for bone densitometry. Current status and perspective. Am J Roentgenol 1989; 152: 241.Google Scholar
  33. 33.
    Hui SL, Slemenda CW, Melton U. Baseline measurement of bone mass predicts fracture in white women. Ann Int Med 1989; 111: 355–361.PubMedGoogle Scholar
  34. 34.
    U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd ed. Baltimore: Williams & Wilkins, 1996.Google Scholar
  35. 35.
    Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials. BMJ 1990; 301: 309–314.PubMedCrossRefGoogle Scholar
  36. 36.
    Brett AS. Treating hypercholesterolemia: how should practicing physicians interpret the published data for patients? N Engl JMed 1989; 321: 676–680.CrossRefGoogle Scholar
  37. 37.
    Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study. Lancet 1994; 344: 1383–1389.Google Scholar
  38. 38.
    Ettinger B, Friedman GD, Bush T, Quesenberry CP. Reduced mortality associated with long-term postmenopausal estrogen therapy. Obstet Gynecol 1996; 87: 6–12.PubMedCrossRefGoogle Scholar
  39. 39.
    Farmer ME, White LR, Brody JA, et al. Race and sex differences in hip fracture incidence. Am JPublic Health 1984; 74: 1374–1380.CrossRefGoogle Scholar
  40. 40.
    Grisso JA, Kelsey JL, Strom BL, et al. Risk factors for hip fracture in black women. NEngl JMed 1994; 330: 1555–1559.CrossRefGoogle Scholar
  41. 41.
    Paganini-Hill A, Chao A, Ross RK, et al. Exercise and other factors in the prevention of hip fracture: the leisure world study. Epidemiology 1991; 2: 16–25.PubMedCrossRefGoogle Scholar
  42. 42.
    Holbrook TL, Barrett-Connor E. A prospective study of alcohol consumption and bone mineral density. BMJ 1993; 306: 1506–1509.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Peter S. Millard

There are no affiliations available

Personalised recommendations