BMJ  2006;333:1251-1256 (16 December), doi:10.1136/bmj.39050.597350.47

Clinical Review

Osteoporosis and its management

¹ Addenbrooke's Hospital, Cambridge CB2 2QQ

The first 150 words of the full text of this article appear below.

Fractures caused by osteoporosis affect one in two women and one in five men over the age of 50, resulting in an estimated annual cost to the health services of around £1.8bn (2.7bn; $3.5bn) in the United Kingdom and 30bn in all of Europe.^{1 2} Most patients with osteoporosis are managed in primary care, but a minority will benefit from referral to specialised centres. In recent years considerable advances have been made both in the identification of people at high risk of fracture and in therapeutic options to reduce the risk of fracture. This review focuses on these areas and also on the partnership that is required between primary and secondary care to optimise the management of patients with osteoporosis.

What is osteoporosis?

Osteoporosis results from reduced bone mass and disruption of the micro-architecture of bone (fig 1), giving decreased bone strength and increased risk of fracture, particularly of the spine, hip, . . . [Full text of this article]

What causes osteoporosis?

Methods
Ongoing research

Who is at risk of osteoporosis?

Box 1 Risk factors for osteoporosis
Independent of bone mineral density
Depending on bone mineral density

How does osteoporosis present?

Who should be treated?

Box 2 Routine investigations to exclude secondary causes of osteoporosis

Management of osteoporosis

Non-pharmacological measures
Pharmacological interventions
Bisphosphonates
Strontium ranelate
Raloxifene
Parathyroid hormone peptides
Hormone replacement therapy
Calcium and vitamin D
Monitoring of treatment
Summary points
Patient's story
Tips for non-specialists
Additional educational resources
Information resources for patients

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