Postmenopausal osteoporosis: Current management of the disease

The current management of osteoporosis is based on several keypoints. The first critical step is to identify patients at high risk of fragility fracture, especially those who already sustained a first fracture, but still not often treated. Evaluating fracture risk includes not only bone-mineral density measurement and age, which are the two main risk factors, but also other clinical risk factors. Treatment decision is then based on estimated level of absolute fracture risk over 10 years. In fact, the main goal of postmenopausal osteoporosis treatment is to reduce this risk of fragility fracture. Treatment choice is based both on drug properties demonstrated by clinical trials and the specific fracture risks of each patient. In addition, it is important to identify whether patients are at risk of vertebral fractures or else at risk of vertebral and nonvertebral fractures. Duration of treatment is at least four to five years after which individual-fracture risk has to be reevaluated. As in many other chronic disease treatments, adherence to therapy is poor and has to be carefully assessed by all health-care professionals. (c) 2008 Elsevier Masson SAS. All rights reserved.