Towards an individualised approach to management of osteoporosis

Abstract

The treatment and management of osteoporosis, like any other disease, should be evidence‐based in order to give the patients the best chance of limiting the conse‐ quences of the disease. Osteoporosis is a very common condition, affecting more women than men, and often overlooked and undertreated. The updated clinical prac‐ tice guideline on postmenopausal, glucocorticoid indu‐ ced, and male osteoporosis from the Spanish Society for Bone and Mineral Metabolism Investigation (SEIOMM) 1 is an important tool for clinicians with respect to diag‐ nosis, future fracture risk assessment, and treatment of osteoporosis.The diagnostic criteria are based on DXA and the pre‐ sence of fractures, the criteria are not new, but the em‐ phasis on recent fractures is new and worth noticing. A patient with a prior major osteoporotic fracture has a hig‐ her risk of fracture than a person at the same age without a fracture for up to 10 years following the first fracture, however, the risk in the 2 years immediately following the fracture is several times higher 2 . Therefore, the period fol‐ lowing a fracture is a window of opportunity for preven‐ tion of the next fracture. The Fracture Liaison Service concept was developed to reduce the worldwide gap in fracture patients being assessed for osteoporosis. The concept was developed more than 2 decades ago and although being implemented at a variable rate around the world, more and more evidence seems to suggest that the concept of systematically investigating fracture patients for osteoporosis is a cost‐effective ap‐ proach by reducing the risk of the next fracture 3 . The guideline divides postmenopausal women with osteoporosis into three risk categories based on a com‐ bination of prevalence of fractures, BMD and clinical risk