What is the best approach to prevention and treatment of osteoporosis?
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Randomized controlled trials (RCTs) have demonstrated decreased vertebral and nonvertebral fracture rates in postmenopausal osteoporotic women taking a bisphosphonate (alendronate or risedronate). Hormone replacement therapy (HRT) also has some evidence for osteoporotic fracture prevention. Concurrent calcium and vitamin D may also prevent fractures. Physical exercise and smoking cessation have been associated with increased bone density, but fracture prevention has not been reported (Grade of Recommendation: B, some extrapolation from individual trials needed).