Metabolic bone diseases.

Metabolic bone diseases often present in old age and some are more easily treatable than others. Osteoporosis is best managed by prevention, with maximisation of peak bone density and reduction of subsequent bone loss. Although hormone replacement therapy is most useful in prevention, it also has a role in established osteoporosis. Other treating agents include calcium, calcitriol, calcitonin and bisphosphonates. Osteomalacia in the elderly mainly results from vitamin D deficiency and supplementation should be considered in those at risk. The newer bisphosphonates show great promise in the treatment of Paget's disease, while surgery remains the only treatment option in primary hyperparathyroidism.