Osteoporosis is no longer a "hidden" disease. This review summarizes what has been revealed in the last few years. The epidemiologic, socioeconomic, physiological, and pathophysiologic factors are considered and documented in detail. Genetic and gender (males are not excluded) factors as well as life style, nutrition, and disease impacts on bone mineral metabolism are examined. Bone architecture and the biochemistry of bone formation and resorption are illustrated and explained in terms relevant to the diagnosis and treatment of osteoporosis and related disorders. The role of the various methodologies of diagnosis based on the biochemistry and biomechanics of bone architecture and metabolism are defined. Issues relating to the precision, cost, and practical applications of the various methods of densitometry, clarification of T and Z scores, and defining the role of laboratory bone formation and resorption markers are delineated. With the diagnosis established (osteopenia or osteoporosis) and with related disorders addressed, a rationale for osteoporosis prevention and therapy is provided. A practical analysis of various nutritional factors, including vitamins and minerals and the role of antiresorptive pharmacological agents, including hormones, bisphosphonates, calcitonin, and the potential role of parathormone as a bone formation agent are carefully documented. Last, and definitely not least, the rehabilitative factors leading to fracture prevention, postural changes, pain control, and restoration of function are considered. Specific insights into the role of resistive exercise and, in particular, site-specific isometric exercises as an efficient, simple, effective muscle and bone-strengthening exercise program is detailed. This critical review of osteoporosis provides an up-to-date understanding of the disorder, with practical strategies for precise diagnosis and successful therapies. Of particular importance, the essential tools for preventative and therapeutic rehabilitation of the osteoporosis patient are stressed.
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Robert L. Swezey (2000) studied this question.