Prevention of postmenopausal osteoporosis.

Prevention of osteoporosis is clearly the preferred approach, since treatment of the established disorder is less than satisfactory. However, accurate identification of those at risk for fractures is impossible at present. By judicious use of risk assessment and the addition of bone mass measurements in the postmenopausal patient, the physician can define a group of patients who will be at some increased likelihood of subsequent osteoporosis. Since estrogen therapy is the most effective single agent for prevention of bone loss, estrogens can be recommended for this group of patients, if otherwise not contraindicated. The addition of a progestogen to the regimen may add to the effect of estrogen by stimulating bone formation. Estrogen therapy may have other effects in the postmenopausal patient population that must be considered when deciding about the introduction of therapy.