Background:The name osteoporosis refers to a condition of diminished mineral content of the bone structures in the body. The most common cause of osteoporosis is the decreased estrogen effect in women after the menopause. Even men with low testosterone concentration and consequently low estrogen hormones in blood may develop osteoporosis at older age. Physical inactivity and obesity in the elderly are correlated with osteoporosis. In Sweden approximately 500.000 people above the age of 50 (i.e. 12% of the population above 50) have osteoporosis (2010). 80% of these are women, and the age gradient is steep.

Symptoms: Decreased mineral content in bone structures may cause pain in weight bearing bones as the femoral bones and the vertebrae. Greater degrees of osteoporosis caries an increased risk of bone fractures and delayed healing of fractures.

Diagnosis: Measurement by a special x-ray procedure(DEXA) is made of the bone mineral content of the lumbar spine, the femoral neck or the total hip. A T-score of more than 2.5 standard deviations from normal defines osteoporosis. A calculated 10 years fracture risk of more than 20 % warrants treatment regardless of the T-score.

Treatment:Calcium and vitamin D medications have been widely used for more than 50 years as supplementations to food to prevent osteoporosis, but with minimal effect. Estrogen medications in postmenopausal women and testosterone in men have been used to prevent or treat osteoporosis. They are no longer used with this indication because of side effects. For many years bisphosphonates have been effective prevention and treatment of osteoporosis, but long-term treatment for more than four to five years has appeared to increase the risk for some very specific spontaneous bone fractures. These fractures are now effectively prevented by one to two years of pretreatment of osteoporosis with analogs of parathyroid hormone that remodels the bone structure and prevents these specific fractures during subsequent treatment with bisphosphonates. Osteoporosis caused by long-term treatment with high doses of cortisol can be effectively treated by analogs of parathyroid hormone.
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