Osteoporosis--diagnosis, treatment and management.

BACKGROUND Osteoporosis is common, asymptomatic and usually undetected until a fracture occurs. Fracture, particularly hip fracture, can be associated with significant mortality, morbidity and loss of independence. OBJECTIVE This article presents a practical case based approach to identify and manage osteoporosis. DISCUSSION The major risk factors for osteoporosis in men and women are known, and case finding by dual X-ray absorptiometry and treatment with effective medications are subsidized by the commonwealth government. At the menopause, symptomatic women considering oestrogen replacement should assess their individual risk of osteoporosis, cardiovascular events and breast cancer. Men also develop osteoporosis and this should be on the health agenda along with cardiovascular disease, prostate and colon cancer, and diabetes. Treatment should include supplemental calcium and occasionally vitamin D. There is strong evidence for the benefits of bisphosphonates, the selective oestrogen receptor modulators and oestrogen replacement.