Guidelines for the diagnosis, screening, and treatment of osteoporosis in women

PURPOSE: To review the epidemiology, screening, diagnosis, and treatment of osteoporosis in women. EPIDEMIOLOGY: Osteoporosis affects more than 8 million women in the United States, leading to 1.5 million fractures yearly. REVIEW SUMMARY: The morbidity and mortality caused by osteoporosis have a significant impact on US healthcare costs. Effective diagnostic tools are available, including single x-ray absorptiometry, dual x-ray absorptiometry (DEXA), quantitative computed tomography, and ultrasound. Of these tools, DEXA is most commonly used. Laboratory screening is also recommended for premenopausal women without significant risk factors. Prevention of this disease is important because lifestyle changes, such as calcium supplementation, weight-bearing exercise, and cessation of smoking, all can have a significant effect on the risk of fracture. Available treatments include calcium, vitamin D, bisphosphonates, and low-dose estrogen. Each therapy has advantages and disadvantages, and treatment should be tailored to the needs of individual patients. Pharmacologic therapies under investigation include antiresorptive agents, statins, intravenous pamidronate, and zoledronic acid. Monitoring of treatment with DEXA and/or biochemical markers is important to ensure effective therapy. TYPE OF AVAILABLE EVIDENCE: Randomized-controlled trials, electronic textbooks, and nationally recognized treatment guidelines. GRADE OF AVAILABLE EVIDENCE: Fair. CONCLUSION: Osteoporosis is a major cause of morbidity and mortality. Given current demographic trends, the burden of this disease will continue to increase. Increased screening, prevention, and treatment can mitigate the negative impact of this disease on individuals and on US healthcare costs.