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NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy

JAMA. 2001;285:785-795.

ABSTRACT
Objectives  To clarify the factors associated with prevention, diagnosis, and treatment of osteoporosis, and to present the most recent information available in these areas.

Participants  From March 27-29, 2000, a nonfederal, nonadvocate, 13-member panel was convened, representing the fields of internal medicine, family and community medicine, endocrinology, epidemiology, orthopedic surgery, gerontology, rheumatology, obstetrics and gynecology, preventive medicine, and cell biology. Thirty-two experts from these fields presented data to the panel and an audience of 699. Primary sponsors were the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health Office of Medical Applications of Research.

Evidence  MEDLINE was searched for January 1995 through December 1999, and a bibliography of 2449 references provided to the panel. Experts prepared abstracts for presentations with relevant literature citations. Scientific evidence was given precedence over anecdotal experience.

Consensus Process  The panel, answering predefined questions, developed conclusions based on evidence presented in open forum and the literature. The panel composed a draft statement, which was read and circulated to the experts and the audience for public discussion. The panel resolved conflicts and released a revised statement at the end of the conference. The draft statement was posted on the Web on March 30, 2000, and updated with the panel's final revisions within a few weeks.

Conclusions  Though prevalent in white postmenopausal women, osteoporosis occurs in all populations and at all ages and has significant physical, psychosocial, and financial consequences. Risks for osteoporosis (reflected by low bone mineral density [BMD]) and for fracture overlap but are not identical. More attention should be paid to skeletal health in persons with conditions associated with secondary osteoporosis. Clinical risk factors have an important but poorly validated role in determining who should have BMD measurement, in assessing fracture risk, and in determining who should be treated. Adequate calcium and vitamin D intake is crucial to develop optimal peak bone mass and to preserve bone mass throughout life. Supplementation with these 2 nutrients may be necessary in persons not achieving recommended dietary intake. Gonadal steroids are important determinants of peak and lifetime bone mass in men, women, and children. Regular exercise, especially resistance and high-impact activities, contributes to development of high peak bone mass and may reduce risk of falls in older persons. Assessment of bone mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. Fracture prevention is the primary treatment goal for patients with osteoporosis. Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or consequences of falls. Adults with vertebral, rib, hip, or distal forearm fractures should be evaluated for osteoporosis and given appropriate therapy.

Consensus Development Panel: Panel and Conference Chair: Anne Klibanski, MD, Professor of Medicine, Harvard Medical School, Boston, Mass; Lucile Adams-Campbell, PhD, Howard University Cancer Center, Washington, DC; Tamsen Bassford, MD, Department of Family and Community Medicine, Health Sciences Center, University of Arizona, Tucson; Steven N. Blair, PED, Cooper Institute, Dallas, Tex; Scott D. Boden, MD, Emory University School of Medicine, Decatur, Ga; Kay Dickersin, PhD, Department of Community Health, Brown University, Providence, RI; David R. Gifford, MD, MPH, Center for Gerontology and Health Care Research, Brown University, Providence, RI; Lou Glasse, MSW, Older Women's League, Poughkeepsie, NY; Steven R. Goldring, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, and New England Baptist Bone and Joint Institute, Boston, Mass; Keith Hruska, MD, Department of Medicine, Washington University, St Louis, Mo; Susan R. Johnson, MD, MS, University of Iowa Colleges of Medicine and Public Health, Iowa City; Laurie K. McCauley, DDS, PhD, Department of Periodontics/Prevention/Geriatrics, University of Michigan, Ann Arbor; William E. Russell, MD, Division of Pediatric Endocrinology, Vanderbilt University Medical Center, Nashville, Tenn. The abstract is prepared by the conference organizers and added to the consensus conference panel's statement as a service for JAMA readers. A listing of speakers and conference sponsors can be found on the Consensus Development Program Web site at http://consensus.nih.gov.

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