Bone Health and Osteoporosis: A Report of the Surgeon General Chapter 9: Prevention and Treatment for Those Who Have Bone Diseases

Prevention and Treatment for Those Who Have Bone Diseases

Key Messages

• There have been important advances in the ability to prevent and treat fractures in the last 10 years, especially in those with skeletal fragility. Just as with the use of diagnostic measures, there has been a failure in the United States to apply appropriate preventive and treatment measures to many persons at risk for bone disease.
• Everyone should be informed of the basic elements of maintaining bone health and preventing bone disease. Paying attention to the basics—appropriate physical activity, nutrition, and smoking—is critical for everyone, especially those who have, or who are at risk of developing, osteoporosis.
• Any individual who is diagnosed with osteoporosis should be evaluated for potential secondary causes of the disease, including the presence of other disorders or the use of medications that can cause harm to bone. If secondary causes are present, actions should be taken to minimize their impact.
• For the most common bone diseases, drugs that prevent bone breakdown (antiresorptives) have been shown to be effective in reducing the risk of future fractures. These drugs not only slow any further deterioration of the skeleton, but also allow for some repair and restoration of bone mass and strength.
• When antiresorptive therapy is not enough, anabolic therapy is available to help build new bone and further reduce the risk of fracture. While this approach has been developed for the prevention and treatment of osteoporotic fractures, it can also be applied to other bone diseases.
• For individuals who remain at high risk of fracture, an extensive fall prevention program should be developed. This program should aim to minimize the risk of falls in the home and community; avoid the use of drugs that increase the risk of bone disease or falls; and protect those who do fall through the use of hip protectors.
• Specific, effective treatments exist for a number of bone diseases other than osteoporosis, including hyperparathyroidism, rickets, and osteomalacia. Treatment is also available for some congenital bone disorders and for bone disease associated with kidney failure. For all of these conditions, early detection and treatment are critical to avoiding crippling deformities and fractures.