Volume 181 - Issue 5
Treatment of osteoporosis: why, whom, when and how to treat
Authors: Ego Seeman and John A Eisman
Med J Aust 2004; 181 (5): 287-288. || doi: 10.5694/j.1326-5377.2004.tb06283.x
Published online: 6 September 2004
Published online: 6 September 2004
Ego Seeman,* John A Eisman†
* Professor of Medicine and Endocrinologist, Austin Hospital, Studley Road, Heidelberg, VIC 3084. † Professor of Medicine, and Director, Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, NSW. egosATunimelb.edu.au
In reply: Our article concerned a discussion of evidence-based treatment for the prevention of osteoporotic fractures. Prevention of osteoporosis per se is important, but the approaches chosen must be evidence- based. Calcium supplementation may diminish, but not abolish, bone loss by reducing remodelling rate.1 Any association of a lifelong diet high in calcium appears to be with peak bone mass, not rates of bone loss,2 and may be attributable to differences in protein intake or physical activity. Despite opinion, meta-analysis of prospective, randomised, double-blind, placebo-controlled studies does not support a role for calcium supplementation in reducing fractures.3
Later rather than earlier intervention avoids needless exposure to treatment for large numbers of individuals at low absolute risk of fracture (ie, those who are unlikely to sustain a fracture even without treatment).4 Vitamin D is of course indicated in vitamin D deficiency. However, there is no evidence for anti-fracture efficacy of vitamin D in ambulant community dwellers.5
Competing interests
E S has been paid to sit on medical advisory boards for Aventis, Eli Lilly, and Merck Sharp & Dohme; J A E has been a paid consultant for Aventis, Eli Lilly, Merck Sharp & Dohme, NPS (USA), Organon, Roche and Servier.
References
- Dawson-Hughes B, Harris SS, Krall A, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age and older. N Engl J Med 1997; 337: 670-676.
- Matkovic V, Kostial K, Simonovic I, et al. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutrition 1979; 32: 540-549. i1085571
- Shea B, Wells G, Cranney A, et al. Osteoporosis Methodology Group; Osteoporosis Research Advisory Group. Calcium supplementation on bone loss in postmenopausal women. Cochrane Database Syst Rev 2004; 1: CD004526. i1085573
- Laupacis A, Sackett DL, Roberts RS. An assessment of clinically useful measures of the consequences of treatment. N Engl J Med 1988; 318: 1728-1733. i1085575
- Lips P, Graafmans WC, Ooms ME, et al. Vitamin D supplementation and fracture incidence in elderly people. Ann Intern Med 1996; 124: 400-406. i1085577