Sophie Jamal, MD, FRCPC, Osteoporosis Research Fellow, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON.
Osteoporosis, defined as a reduction in bone mass leading to an increased susceptibility to fracture with minimal trauma, affects 1.4 million Canadians.1 Osteoporotic hip and vertebral fractures are major causes of disability and premature death. For example, the average length of stay in an acute care hospital after a hip fracture is three weeks, and one in four patients must remain in long-term care institutions for at least one year. Furthermore, patients with hip and vertebral fractures face a 20% increased risk of mortality.2 Osteoporosis is also costly--in Canada, in 1993, the total expenditure for fractures was estimated to be 1.3 billion dollars.3 As the population of Canada ages, the impact of osteoporosis will increase. As such, health care providers should be aware of techniques to prevent fractures due to osteoporosis.
In addition to encouraging physical activity and ensuring adequate calcium and vitamin D intake, several medications can be used to prevent osteoporotic fractures. These drugs, which have been studied predominantly in postmenopausal women, include bisphosphonates, estrogen, selective estrogen receptor modulators and calcitonin. The evidence that supports the use of these agents to prevent bone loss and fractures in postmenopausal women is reviewed below.