NIH Consensus Panel Addresses Osteoporosis Prevention, Diagnosis, and Therapy

Osteoporosis Prevention
Osteoporosis Diagnosis
Osteoporosis Therapy


Nutrition, exercise, and medicines can play important roles in the prevention and treatment of osteoporosis, according to an independent, non-Government consensus panel convened by the National Institutes of Health (NIH). Panel members acknowledged that maintaining optimal bone health is a lifelong process for men and women that begins in childhood. The panel issued its statement at the conclusion of a 3-day NIH Consensus Development Conference on Osteoporosis Prevention, Diagnosis, and Therapy. The conference, held March 27-29, 2000 at the NIH, brought together national and international experts to present the latest research findings on osteoporosis, a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture.

"Osteoporosis occurs in all populations and at all ages and is a devastating disorder with significant physical, psychosocial and financial consequences," said panel chair Anne Klibanski, M.D., professor of medicine at Harvard Medical School in Boston. About 10 million people in the United States have osteoporosis, making it the most prevalent metabolic bone disorder in this country. An additional 18 million individuals already have low bone mass, placing them at increased risk for this disorder.

The panel was charged with addressing the following five questions:

• What is osteoporosis and what are its consequences?
• How do risks vary among different segments of the population?
• What factors are involved in building and maintaining skeletal health throughout life?
• What is the optimal evaluation and treatment of osteoporosis and fractures?
• What are the directions for future research?

"Osteoporosis is commonly the result of bone loss," said Dr. Klibanski. "It may also occur in individuals who do not achieve adequate bone mass during childhood and adolescence." She added that bone mass attained during childhood is perhaps the most important determinant of life-long skeletal health, a fact that is under-appreciated. Achieving optimum bone mass early in life reduces the impact of bone loss related to aging. Genetic factors exert a strong influence on peak bone mass, but controllable environmental and lifestyle factors also play a role. These include good nutrition, particularly adequate calcium and vitamin intakes. Only 10 percent of girls and 25 percent of boys between ages 9 and 17 obtain an adequate amount of calcium in their diet through the consumption of dairy products and vegetables.

There is strong evidence that physical activity early in life contributes to higher peak bone mass. Clinical trials have shown that exercise reduces the risk of falls by approximately 25 percent. Falls are a major cause of fractures in people with osteoporosis.

Although hormone replacement therapy remains a common treatment and prevention option, the panel suggested that more information is needed on how estrogen alone or in combination with other treatments reduces the incidence of fractures. Natural estrogens, such as plant-derived phytoestrogens, have thus far not been shown to reduce fractures. Within the last decade, new medicines to help prevent and/or treat osteoporosis have become available. Among the new classes of drugs are bisphosphonates and selective estrogen receptor modulators.

New technologies have improved the detection of loss of bone mineral, a key predictor of osteoporotic fracture. Dual energy X-ray absorptiometry (DXA) is the standard for measuring bone mineral density of the hip. Other measures of bone strength, such as ultrasound of the heel, are as effective in predicting hip fracture. However, the panel recognized that no standard exists for comparing different devices.

The panel's recommendations for future research include identifying and intervening in disorders that can impede the achievement of peak bone mass in children of ethnic diversity; improving diagnosis and treatment of secondary causes of osteoporosis, such as that resulting from the use of glucocorticoids (for example, prednisone); collecting data necessary to establish testing guidelines for osteoporosis; developing quality-of-life measurement tools that incorporate gender, age and race/ethnicity; conducting randomized clinical trials of combination therapies to prevent or treat osteoporosis; and developing a paradigm for the management of fractures.

The full NIH Consensus Statement on Osteoporosis Prevention, Diagnosis, and Therapy is available by calling 1-888-NIH-CONSENSUS (1-888-644-2667) or by visiting the NIH Consensus Development Program Web site at http://consensus.nih.gov.

The NIH Consensus Development Program was established in 1977 to resolve in an unbiased manner controversial topics in medicine. To date, NIH has conducted 110 such conferences addressing a wide range of controversial medical issues important to health care providers, patients, and the general public.

The conference was sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the NIH Office of Medical Applications of Research. Cosponsors included the National Institute on Aging; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Dental and Craniofacial Research; National Institute of Child Health and Human Development; National Institute of Nursing Research; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; NIH Office of Research on Women's Health; and Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research)