Prevention of postmenopausal osteoporosis. Part 1: Identification of patients at risk and nonhormone preventive measures

Background. Osteoporosis is one of the most frequent and cost-intensive diseases. In women aged >50 years and in postmenopausal women of all ages suffering from malnutrition or having an insufficient exposition to sunlight leading to low serum vitamin D levels, an adequate calcium intake, a sufficiently high vitamin D supplementation increasing with age and a sufficient protein intake (minimally 1 g/kg body weight protein per day) are essential for primary prevention of osteoporotic fractures. Vitamin D supplementation. Vitamin D prevents fractures through two mechanisms. Vitamin D has a positive effect on bone metabolism, and vitamin D increases muscle strength, resulting in a decreased risk of falls. Some sources recommend a vitamin D intake of 800-1000 IU/day. However, others suggest 1500-2000 IU/day vitamin D for adults aged >19 years. In the elderly having a high fracture risk, up to 2000 IU vitamin D/day is recommended. Calcium supplements. The preventive effect of vitamin D implies a sufficient, but not excessive daily calcium intake. To prevent osteoporotic fractures, a preferentially alimentary calcium supplementation of 1000-1200 mg/day calcium is recommended. The efficiency and safety of an adequate calcium and vitamin D supplementation has been proven. In particular, in studies observing the calcium intake limits defined above, no increased cardiovascular risk was observed. Uncontrolled additional calcium intake is not indicated. General measures. General prevention includes regular physical exercise (including strength training) combined with equilibrium training to prevent falls. Risk factors such as cigarette smoking, excessive alcohol intake and-if possible-the intake of drugs having a negative impact on bone metabolism (e.g., glucocorticoids, antiepileptics, suppressive thyroid hormone therapy) should be avoided. General preventive measures can be recommended without specific diagnostic investigations. Each therapeutic decision has to be preceded by an appropriate investigation for osteoporosis and prevalent fractures