Osteoporosis: Who,when,how Long to Treat,and with what Effectiveness?

The burden of osteoporosis is increasing due to the longevity of the population as well as due to increases in age- and sex-specific rates. With a better understanding of causation, treatment and intervention strategies require development. Global strategies aimed at the population to decrease fracture risk have not been tested so that greatest attention has been devoted to high-risk strategies where segments of the community are identified for treatment. There is a poor case for screening women at the time of menopause with assessment of bone mineral density. The rationale for screening in later life is much stronger but has not been tested. In the meanwhile, a case-finding approach is advocated where individuals at particular risk are identified by the presence of clinical risk factors. In such patients treatments can be cost-effectively targeted and cost effectiveness improved further by assessment of bone mineral density.