Fragile Bones

Our focus this issue is on osteoporosis, a topic that is finally starting to get the respect it deserves. During my residency days in the 1970s, those physicians who were interested in osteoporosis and its treatments were considered to be working outside of mainstream medical practice. Now we know that they were in fact pioneers, if not visionaries. We recognize today that men as well as women are affected by osteoporosis, and that the consequences of this disease are dramatic, causing impaired quality of life and, in some cases, premature death. Yet we still have a long way to go both in recognition of the disorder and in its management. It has long been recognized that osteoporosis is not a disease of old age per se, but rather a disease of young life with manifestations in old age. In fact, one of the first major articles pointing out that peak bone mass in early adult life was a major predictor for late-life osteoporosis and fractures was by a geriatrician, Norman Exton-Smith. Population-based strategies for prevention of osteoporotic fractures will thus have to be based on ways of building bone mass in early life.

In her article, Dr. Rowena Ridout outlines the process of “Osteoporosis Screening and Diagnosis.” Dr. Panagiota Klentrou reviews the role of “Physical Activity for the Prevention and Treatment of Osteoporosis,” while Drs. Susan Whiting and Hassanali Vatanparast write about “Nutritional Interventions in Osteoporosis.” Cathy Kessenich reviews the “Nonpharmacologic Prevention and Management of Osteoporosis,” while the noted scientist in osteoporosis research, Dr. Angela Cheung, informs us about “New Drug Therapies in Osteoporosis.”

In our cardiovascular column Drs. Julian Jarman and Tom Wong review the “Modern Management of Arrhythmias in the Older Population.” Drs. Gordon Searles and Joseph Coffey review “Malignant Photo Damage” in their skin column; be wary when you go south on your winter vacation! A spin-off from the Women’s Health Initiative has been the question of managing symptomatic menopause. In her women’s health column, “Symptomatic Menopause--What are the Safe and Effective Options?”, Dr. Jerilynn Prior answers this query. Finally, our case study this month is “A Case of Iron Deficiency Anemia” by Dr. Anna Monias with commentary by Dr. Duane Sheppard.

Enjoy this issue.
Barry Goldlist