Management of osteoporosis in the new millennium.

Key to effect management of osteoporosis is early diagnosis. Careful assessment of risk and determination of bone mineral density can enable the clinician to recognize this disease before it manifests with fractures. Treatment strategies have been shown to reduce fracture rates and potentially improve bone mineral content. Effective nonpharmacologic treatment includes nutritional considerations, exercise, prevention of falls, behavioral alterations, and osteopathic manipulative treatment. Approved pharmacologic strategies include estrogen replacement therapy, alendronate, and calcitonin. Because of the multiple health benefits of estrogen replacement therapy, unless contraindicated, it should be used whenever possible. The effectiveness of combination therapy is yet to be determined. Serial determinations of bone mineral density and the use of urinary biomarkers are effective to monitor therapy. A "four-step approach" to management is proposed. The primary physician can play a key role in the early recognition and treatment of this potentially devastating disorder.