Authors' objectives: The aim of this project was to systematically and critically assess the scientific evidence on the effectiveness of various interventions for the prevention, diagnosis and treatment of osteoporosis.

Authors' recommendations: Osteoporosis is a common condition in Sweden. One in three women aged 70 through 79 years is found to have osteoporosis, revealed by measuring bone density in the hip. Osteoporosis may lead to fractures following minor stress on the bone. Annually, osteoporosis is associated with approximately 70 000 fractures, whereof 18 000 are hip fractures. The quality of life deteriorates for many hip fracture patients, and the mortality rate is high. Hip fractures account for more than one half of all direct healthcare costs related to fractures. The national economic costs for osteoporosis and osteoporosis-related fractures total approximately 3.5 billion SEK per year. Patients with osteoporosis-related fractures are an undertreated group as regards pharmacotherapy and other interventions to prevent new fractures. A diagnosis of osteoporosis is seldom included in the admission or discharge reports of patients with hip fractures. Important risk factors for osteoporosis-related fractures that can be treated are physical inactivity, low weight, tobacco smoking, high alcohol consumption, tendency to fall, impaired vision, low exposure to sunlight, and use of corticosteroids. Osteoporosis is only one of several risk factors for fractures. Bone density measurement has little likelihood of predicting hip fracture in individuals who are otherwise at small risk for fracture. Important risk factors that cannot be influenced include old age, female gender, previous fracture, and heredity. The value of bone density measurement is greater in those with multiple risk factors. No particular diagnostic method or measurement site is optimal for determining the risk for fracture in all parts of the skeleton. Measurement of bone density in the hip is best for predicting the risk for hip fracture. Measurements in the vertebrae are best for predicting vertebral fracture. There is more uncertainty regarding comparisons of the various measurement methods dual energy x-ray absorbtiometry (DXA), ultrasound, and computed tomography (CT). Physical exercise for at least 30 minutes, 2 to 3 times per week, has a positive effect on bone density in both girls and boys. This effect probably remains throughout young adulthood. Physical activity is particularly important in children and teenagers, when maximum bone mass is formed. Weight-bearing training such as jumping, aerobic exercise, endurance training, and weight lifting probably have the greatest effects on bone density. High calcium intake, mainly from dairy products, is thought to increase bone density in children and teenagers, but the effect on ultimate bone mass has not been sufficiently studied. Increased calcium intake prior to menopause is thought to be important, but the positive effects may be a consequence of generally favorable nutritional conditions. There is no scientific evidence to support the use of bone density measurement as a screening method in healthy, middle-aged individuals. However, bone density measurement plays an important role in examining individuals with multiple risk factors to predict their fracture risk and initiate preventive interventions. Pharmacotherapy: Calcium and vitamin D are shown to reduce the risk for hip fracture and other fractures, except vertebral fractures, in elderly women. Alendronate and risedronate (bisphosphonates) are shown to reduce the number of fractures, mainly vertebral fractures, in postmenopausal women with osteoporosis. Estrogen has been shown to reduce the number of fractures, but its applicability is limited due to increased risk for undesirable side effects. Selective estrogen-receptor modulators (SERM) are shown to reduce the risk for vertebral fractures in postmenopausal women with osteoporosis. Hip protectors appear to reduce the risk for hip fractures or falls among the elderly in residential facilities (nursing homes). To reduce the number of falls among elderly, the following interventions are shown to be important: individually designed muscle strength and balance training, interventions against the risk for falls at home, combination of training and modification of risk for falls, including a reduction in medication. The following important knowledge gaps have been identified: studies in men concerning pharmacotherapy, fracture prediction by bone density measurement, and assessment of rehabilitation interventions following fracture studies of hip protectors and interventions to prevent falls and reduce fractures among unselected groups in various residential care settings - studies concerning the effects of physical activity on the risk for fractures - studies concerning individuals with impaired cognitive function. Economic assessments are lacking, due mainly to insufficient knowledge concerning the effects of various osteoporosis treatments on risks, mortality, quality of life, and costs in different age groups and risk groups.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2003

URL for published report: https://www.sbu.se/en/publications/sbu-assesses/osteoporosis---prevention-diagnosis-and-treatment/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: Swedish Council on Technology Assessment in Health Care (SBU)