Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Executive summary.

This report describes evidence for the diagnosis, prevention, and treatment of osteoporosis in postmenopausal healthy white women. Osteoporosis is becoming an increasingly important public health problem as our population ages. Although it is partially preventable, fractures related to osteoporosis are still common. Because of the economic and social burdens, comprehensive prevention programs are needed. Insufficient data prevent development of comparable analyses for men or nonwhite women. Discussed are the effectiveness, risks, and costs of diagnostic tests and treatments, the probabilities that women will have osteoporosis-related fractures, and the effects of various factors on these probabilities. Hormone replacement therapy is considered most cost-effective; women who refuse hormone replacement can consider bisphosphonates (alendronate) and calcitonin. Nomograms are presented for guiding treatment and testing decisions for individual patients. The following public health measures are recommended: Ensure that adults receive the optimal daily intake of calcium--between 1000 mg and 1500 mg; ensure that people at risk for vitamin D deficiency receive 400 IU to 800 IU of vitamin D daily; inform people that exercise, in addition to its other benefits, should help prevent osteoporosis; and discourage people from smoking.