Search

Insufficient calcium intake results in increased bone resorption leading to osteoporosis. In this situation a normal serum calcium level is maintained at the cost of the skeleton, i.e. development of secondary hyperparathyroidism. Vitamin D enhances intestinal calcium absorption and osteoid mineralization and reduces parathyroid hormone secretion. Therefore, calcium and vitamin D supplements are generally recommended for prevention and as a basic therapy of osteoporosis. When dosing these supplements nutritional calcium and vitamin D synthesis during sun exposure have to be taken into consideration. It is also important to take into consideration that calcium intake and intestinal absorption as well as vitamin D production decrease with increasing age. Calcium intake should be in the range of 1000-1500 mg and vitamin D 800-2000 IU per day or 25-hydroxy-vitamin D plasma levels between 30 and 50 ng/ml. With these dosages hypercalcemia and hypercalciuria are extremely rare adverse events and the risk of kidney stones is very low. Communications of increased cardiovascular events related to long-term calcium or calcium and vitamin D intake induced a significant reduction of prescriptions of corresponding preparations. Other publications, however, communicated cardioprotective effects of vitamin D and recent publications could not confirm an increased risk of cardiovascular events with calcium alone or in combination with vitamin D and even demonstrated reduced mortality. Until final clarification of these discrepant study results a regular moderate intake of calcium and vitamin D supplements within the abovementioned dosage range is recommended.

Although additional fracture data are needed to endorse the clinical care of osteoporosis in men, consensus views were reached on diagnostic criteria and intervention thresholds. Empirical data in men display similarities with data acquired in women, despite pathophysiological differences, which may not be clinically relevant. Men should receive treatment at a similar 10-year fracture probability as in women. The design of mixed studies may reduce the lag between comparable treatments for osteoporosis in women becoming available in men.

Background: Osteoporosis is predominantly a condition of the elderly, and the median age for hip fracture in women is approximately 83 years. Osteoporotic fracture risk is multifactorial, and often involves the balance between bone strength and propensity for falling. Objective: To present an overview of the available evidence, located primarily by Medline searches up to April, 2009, for the different management strategies aimed at reducing the risk of falls and osteoporotic fractures in the elderly. Results: Frailty is an independent predictor of falls, hip fractures, hospitalisation, disability and death in the elderly that is receiving increasing attention. Non-pharmacological strategies to reduce fall risk can prevent osteoporotic fractures. Exercise programmes, especially those involving high doses of exercise and incorporating balance training, have been shown to be effective. Many older people, especially the very elderly and those living in care institutions, have vitamin D inadequacy. In appropriate patients and given in sufficient doses, vitamin D and calcium supplementation is effective in reducing both falls and osteoporotic fractures, including hip fractures. Specific anti-osteoporosis drugs are underused, even in those most at risk of osteoporotic fracture. The evidence base for the efficacy of most such drugs in the elderly is incomplete, particularly with regard to nonvertebral and hip fractures. The evidence base is perhaps most complete for the relatively recently introduced drug, strontium ranelate. Non-adherence to treatment is a substantial problem, and may be exacerbated by the requirements for safe oral administration of bisphosphonates. Conclusion: Evidence-based strategies are available for reducing osteoporotic fracture risk in the elderly, and include exercise training, vitamin D and calcium supplementation, and use of evidence-based anti-osteoporotic drugs. A positive and determined approach to optimising the use of such strategies could