The Diagnosis and Treatment of Primary Osteoporosis According to Current Guidelines

Introduction: Osteoporosis is the most common generalized disease of the skeleton, yet it is markedly undertreated in Germany. Methods: Selective literature review on the basis of the current German guidelines regarding the prevention, diagnosis, and treatment of osteoporosis in postmenopausal women and in men aged 60 and above, and a further search of literature published in the last three years. Results and discussion: The indication for dual X-ray absorptiometry (DXA) measurement for the specific diagnosis of osteoporosis is derived from the patient's age, sex, history of fractures in the past, and further risk factors. The therapeutic threshold for osteoporosis has been set at a 30% predicted risk of osteoporotic fractures occurring within 10 years. The treatment consists of basic measures for fracture prevention combined with specific pharmacotherapy. The recommended drugs for the treatment of osteoporosis in postmenopausal women in particular are alendronic and ibandronic acid, raloxifen, risedronic acid, and strontium ranelate; the only approved drugs for men at present are alendronic and risedronic acid and teriparatid. Intensive patient education markedly improves the otherwise poor compliance with osteoporosis treatment. Dtsch Arztebl Int 2008; 105(33): 573-82 DOI: 10.3238/arztebl.2008.0573