Prevention, screening, and management of osteoporosis: an overview of the current strategies.

Osteoporosis is a major public health concern, resulting in increased fracture risk. Osteoporosis-related fractures impose a considerable economic burden on health care systems, and the disease has severe, debilitating consequences if left untreated. Measures for osteoporosis prevention should begin at childhood and include balanced nutrition, physical activity, and avoidance of risk factors such as smoking. In adulthood, early recognition of osteoporosis followed by timely and effective management can reduce fracture risk. However, the rates of screening and treatment for osteoporosis are low, even in patients who have sustained a fragility fracture. Comprehensive fracture risk assessment should be part of routine patient care. Nonpharmacologic strategies to improve or maintain bone health should always be implemented, but many patients also need pharmacologic intervention to achieve adequate fracture protection. Several pharmacologic therapies are currently available, and when choosing from the available options, clinicians should consider the efficacy and safety profiles of each therapy as well as the individual patient's needs and overall health. Ideally, therapy should satisfy multiple criteria: fracture protection across multiple skeletal sites; rapid onset of action to maximize the timing of fracture protection; and minimal side effects with proven long-term safety.