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Managing osteoporosis: Challenges and strategies
Cleveland Clinic Journal of Medicine, 08/05/09

Lewiecki ME – This paper is a review of unmet needs in the management of osteoporosis and strategies to improve clinical outcomes.

• Osteoporosis is underdiagnosed. Patients discharged from the hospital after hip fractures are commonly not diagnosed with or treated for osteoporosis although the risk of future fractures is very high.
• The Fracture Risk Assessment Tool (FRAX) estimates the 10–year probability of fracture on the basis of clinical risk factors for fracture and the bone mineral density of the femoral neck. The combination of bone mineral density and clinical risk factors predicts fracture risk better than either alone.
• A drug holiday, for 1 year or perhaps longer, may be considered for patients on alendronate (Fosamax) who are no longer at high risk of fracture. On the other hand, given the evidence of increased risk of clinical vertebral fracture and hip fracture after bisphosphonates are discontinued, a drug holiday is probably not a reasonable choice in patients at high risk of fracture.
• Patient education and regular contact with a health care provider may improve compliance and persistence with therapy.

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