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August 10, 1984


JAMA. 1984;252(6):799-802. doi:10.1001/jama.1984.03350060043028

Osteoporosis is a major underlying cause of bone fractures in postmenopausal women and older persons in general. It is a condition in which bone mass decreases, causing bones to be more susceptible to fracture. A fall, blow, or lifting action that would not bruise or strain the average person can easily cause one or more bones to break in a person with severe osteoporosis.

Medical practitioners and patients alike are concerned with the optimum approach to the treatment and prevention of osteoporosis. The appropriate timing and proper use of agents, such as calcium, vitamin D, estrogens, and fluorides, as well as the role of exercise are issues that have generated major research efforts and considerable controversy.

In an effort to resolve some of the questions surrounding these issues, the National Institutes convened a Consensus Development Conference on Osteoporosis from April 2 through 4, 1984. After 1 1/2 days of presentations by experts in the field, a consensus panel including representatives of orthopedics, endocrinology, gynecology, rheumatology, epidemiology, nutrition, biochemistry, family medicine, and the general public considered the evidence and agreed on answers to the following key questions:

  1. What is osteoporosis?

  2. What are the clinical features of osteoporosis, and how is it detected?

  3. Who is at risk for the development of osteoporosis?

  4. What are the possible causes of osteoporosis?

  5. How can osteoporosis be prevented and treated?

  6. What are the directions for future research?

Panel's Conclusions  Osteoporosis is a major public health problem. Although all bones are affected, fractures of the spine, wrist, and hip are typical and most common. The risk of osteoporosis developing increases with age and is higher in women than in men and in whites than in blacks. Its cause appears to reside in the mechanisms underlying an accentuation of the normal loss of bone, which follows the menopause in women and occurs in all persons with advancing age. There are no laboratory tests for defining persons at risk or those with mild osteoporosis. The diagnosis of primary osteoporosis is established by documentation of reduced bone density or mass in a patient with a typical fracture syndrome after exclusion of known causes of excessive bone loss. Prevention of fracture in susceptible patients is the primary goal of intervention. Strategies include ensuring estrogen replacement in postmenopausal women, adequate nutrition including an elemental calcium intake of 1,000 to 1,500 mg/day, and a program of modest weight-bearing exercise. There is great need for additional research on understanding the biology of human bone, defining persons at special risk, and developing safe, effective, and low-cost strategies for fracture prevention.