A rational approach to the prevention and treatment of postmenopausal osteoporosis.

Postmenopausal osteoporosis is a common disorder. Its importance is measured by the mortality and morbidity associated with increasing numbers of fractures and the enormous social and economic cost to the community. Although the precise aetiology of postmenopausal osteoporosis remains unclear, prevention is now possible and treatment may be effective if commenced early enough in the course of the disease. Combination therapy with oestrogens and progestogens is currently the treatment of choice for prevention, in conjunction with calcium supplementation and changes in lifestyle. Prophylaxis should be offered to women at 'high risk', although the identification of this group is difficult at present. Treatment of existing disease is less effective, although oestrogens should be tried first, with calcitonin as a second choice. There is no place at present for vitamin D, anabolic steroids or parathyroid hormone. The use of fluoride or diphosphonates cannot be recommended outside research centres until further long term studies are completed, which will enable a comparison of the relative risks and benefits. Postmenopausal osteoporosis is now a preventable disease; however, further knowledge of risk factors and the identification of those at risk is essential. Treatment can then be directed at women who need it and healthy women can be spared a lifetime of unnecessary medication.