Treatment of postmenopausal osteoporosis

Editor—I was surprised that Reginster's editorial on the treatment of postmenopausal osteoporosis did not mention exercise,¹ which is both the most important factor in its causation and the chief cause of its morbidity.

Thirty five years ago, Chalmers and Ho presented demographic evidence that osteoporotic fractures of the femoral neck were inversely related to the level of physical activity.² Osteoporosis is therefore a disorder of civilisation.

Although osteoporosis predisposes to age related fractures, the essential cause of these fractures is loss of balance and falling. This was shown by Aitken in 1984, who found that those who suffered fractures of the femoral neck had the same bone density as controls.³

Maintaining physical activity into old age, not only conserves bone strength; more importantly it improves muscle coordination and balance, which are crucially important in preventing falls. So we must not let our current enthusiasm for drug treatment of osteoporosis divert us from promoting exercise programmes, which are much more important because they are effective in preventing falls.⁴