the U.S. Preventive Services Task Force guidelines on osteoporosis screening should be reassessed. Related efforts should include quantification of the costs and benefits of estrogen replacement therapy (ERT), especially those relating to its controversial effects on the risk of coronary heart disease and breast cancer, and an investigation of the potential role of screening for men and nonwhite women.

  1. Better therapies are needed to prevent postmenopausal bone loss. New drugs for osteoporosis prophylaxis should be developed and tested that do not have ERT side effects or complications (bisphosphonates, etc.).

  2. The pathophysiology of age-related bone loss should be characterized to help identify new leads for therapy. In particular, the use of ERT for bone loss in the elderly should be evaluated. Controlled clinical trials should also be conducted to investigate the effects of calcium supplements and more realistic exercise programs for preventing bone loss in the elderly.

  3. The prevalence and importance of risk factors for osteoporosis should be determined, including estimations of the national population at risk of fracture by virtue of low bone mass (men as well as women and nonwhites as well as whites) and the prevalence of risk factors (for attributable risk). Any difference in risk factor prevalence among races, genders, regions, or other demographic variables should be identified. Such research should also seek an explanation for the lower fracture risk (as compared to whites) found among Hispanic, black, and Asian populations. In addition, the important causes of secondary osteoporosis should be determined.

  4. An optimal, postfracture rehabilitation program should be developed. Related research should include efforts to generate better data about fracture-related disabilities (especially those resulting from spinal fractures), quantify the determinants of functional impairment after hip or other such fractures, and determine barriers to aggressive rehabilitation. Controlled clinical trials should be conducted to demonstrate the merits of promising rehabilitation activities.

  5. Research should continue on identifying modifiable determinants of serious falls (see Chapter 15).

Education

Policymakers

Recent research findings that bear on governmental policy matters should be interpreted to encourage more informed decisions by



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