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Editor's Choice

Are we at risk of being at risk?

BMJ 2010; 341 doi: (Published 02 September 2010) Cite this as: BMJ 2010;341:c4766

Are we at risk of being at risk?

I would be happy if there were such a thing as pre-hypertension
because it would probably be treatable by simple salt restriction rather
than developing into real hypertension requiring pharmaceutical treatment.
For the same reason, I am delighted that there is such a thing as pre-
osteoporosis (bone density in the low normal range) because that is
undoubtedly treatable with lifestyle measures to prevent it developing
into osteoporosis. My objective is for every woman to have her bone
density measured at menopause, to be given the information and appropriate
advice so that she can take her own steps to prevent osteoporosis in the

Fracture risk can be predicted by bone densitometry up to 25 years ahead (1). There is ample evidence that bone loss and fractures in women can be prevented with calcium and vitamin D in adequate dosage (2,3,4). In Australia, we generally recommend 500 mg of calcium daily as citrate or 1,000 mg as carbonate, both in divided doses, with 1,000 units of vitamin D3 daily. We have several preparations which meet these requirements in a comnined tablet taken morning and evening or a single effervescent drink at night.

Western countries need to pay far more attention to preventive
medicine as a speciality in its own right; osteoporosis is the model for
many other conditions.

1. Duppe H, Gardsell P, Nilsson B, Johnell O, A single bone density measurement can predict fractures over 25 years. Calcif.Tissue Int.1997;60;171-174.

2. Nordin BEC The effect of calcium supplementation on bone less in 32 controlled trials in postmenopausal women. Osteoporosis Int. 2009;20;213-243.

3. Prince RL, Devine A, Dhaliwal SS, Dick IM. Effects of calcium supplementation on clinical fracture and bone structure; results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch. Intern.Med.2006;166;869-75.

4. Abrahamsen B, DIPART (Vitamin D Individual Patient Analysis of Randomised Trials) Group patient level pooled analysis of 68,500 patients from 7 major vitamin D fracture trials in U.S. and Europe. BMJ 2010;340;b5463.

Competing interests: No competing interests

01 October 2010
BE Christopher Nordin
Visiting Professor
Royal Adelaide Hospital & University of Adelaide