Data from National Ambulatory Care Survey from 1993 to 1997 were analyzed in an effort to find evidence of osteoporosis and to assess primary care physicians' diagnosis of osteoporosis and vertebral fracture and their treatment.⁵ During the 5 years of the study, fewer than 2% of primary care physicians (family physicians, general practitioners, internists, obstetricians and gynecologists) diagnosed osteoporosis or vertebral fracture. Further analysis revealed that appropriate drug therapy was offered to only 36% of patients diagnosed with osteoporosis.

Patterns of Bone Loss in Postmenopausal Women
Bone mass increases progressively during growth and for some time after adult height is reached. Peak bone mass is achieved in women in their early 20s with gradual bone loss beginning in their 30s, paralleling an age-related decline in muscle mass. At menopause, women begin a period of accelerated bone loss affecting primarily cancellous bone, losing an average of 1% to 2% annually during the next 10 years. Bone loss is most accelerated in the first 3 to 6 years after menopause, levels off, and then gradually assumes the level of premenopausal bone loss.⁶ This, coupled with the lower peak BMD in women than in men, explains in part the higher incidence of osteoporosis and osteoporotic fractures in women. The accelerated bone loss is hypothesized to be related to increased activity of the osteoclasts compared to the osteoblasts, and increased activation of the basic remodeling unit; both increase bone turnover.^7,8