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Editors' Message  |   February 2013
Promoting Successful Aging Through Effective Prevention and Management of Osteoporosis
Author Notes
  • From the New Jersey Institute for Successful Aging at the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine in Stratford 
  • Address correspondence to Thomas A. Cavalieri, DO, Dean, University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine, One Medical Center Dr, Suite 305, Stratford, NJ 08084-1500. E-mail: cavalita@umdnj.edu  
Article Information
Geriatric Medicine / Neuromusculoskeletal Disorders / Preventive Medicine
Editors' Message   |   February 2013
Promoting Successful Aging Through Effective Prevention and Management of Osteoporosis
The Journal of the American Osteopathic Association, February 2013, Vol. 113, S4. doi:
The Journal of the American Osteopathic Association, February 2013, Vol. 113, S4. doi:
Abstract

Sucessful aging has been described as having 3 components: a low probability of disease and disease-related disability, a capacity for high cognitive and physical function, and active engagement with social and productive activities.1  Osteopathic physicians play a critical role in the promotion of successful aging through the prevention, early detection, and management of osteoporosis. Not many years ago, osteoporosis was viewed as an age-related disorder for which there was a lack of effective approaches for early intervention and management. Now, that view has changed.

More than 10 million people in the United States have osteoporosis.2 Although it is thought to be a disorder predominantly affecting women, it is also common in men, particularly in the seventh and eighth decades of life. One in 2 women and 1 in 4 men older than 50 years will have an osteoporosis-related fracture during their lifetime.3 Hip fractures have the most serious impact on health, usually requiring hospitalization and often resulting in loss of function—one-half of patients who have had a hip fracture are unable to walk without assistance. Vertebral fractures are also associated with serious consequences, including chronic back pain and disability.4 The economic impact of osteoporosis on the health care system amounts to billions of dollars annually.3 
In this supplement to The Journal of the American Osteopathic Association (JAOA), the authors, who participated in a roundtable discussion led by David A. Forstein, DO, share their clinical experience with osteoporosis and present evidence-based data to equip the practicing clinician with state-of-the-art approaches to the prevention, detection, and management of osteoporosis. The public health implications of osteoporosis are discussed by Raymond E. Cole, DO. The impact of the disorder on quality of life through loss of function, pain, and disability is reviewed by Steven T. Harris, MD. The authors present various guidelines for screening, and Dr Harris discusses the benefits and limitations of FRAX, an online tool developed by the World Health Organization to calculate the risk of fracture for patients. Catherine Bernardini, DO, discusses the role of dual-energy x-ray absorptiometry and the T score, whereas Andrea Singer, MD, addresses the significance of the Z score. 
The authors present approaches aimed at fracture prevention, with Dr Cole offering his “CDEFF” mnemonic for reducing fracture risk. Additionally, indications for and limitations of various treatment options, including the use of selective estrogen-receptor modulators and the current role of hormone replacement therapy, are presented. Issues regarding the use of bisphosphonates are discussed, including treatment options and the development of such adverse reactions as osteonecrosis of the jaw and atypical femoral fracture. Dr Cole also reviews the role of osteopathic manipulative medicine. Another discussion focuses on the role of dual-energy x-ray absorptiometry in monitoring therapy. Finally, strategies to enhance treatment adherence, such as follow-up visits, patient reassurance, and effective communication, are presented. 
This supplement to the JAOA provides an outstanding review of osteoporosis, complete with clinical pearls and pragmatic insights for the primary care physician. No matter the age of the patient, an important role of the physician is to enhance quality of life through promoting successful aging. The approach discussed in this supplement, an approach aimed at maintaining bone health and avoiding fracture, is one way to promote successful aging. 
   Financial Disclosures: None reported.
 
References
Rowe JW, Kahn RL. Successful aging. Gerontologist. 1997;37(4):433-440. doi:10.1093/geront/37.4.433. [CrossRef] [PubMed]
Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010. http://www.nof.org/files/nof/public/content/file/344/upload/159.pdf. Accessed January 2, 2013.
Office of the Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: Dept of Health and Human Services; 2004. http://www.surgeongeneral.gov/library/reports/bonehealth/full_report.pdf. Accessed January 2, 2013.
National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. Osteoporosis Handout on Health. Bethesda, MD: Dept of Health and Human Services; October 2011. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/osteoporosis_hoh.asp#risk. Accessed January 2, 2013.