[Fracture prevention: breaking with the guideline?]

We have evaluated the merits and scientific underpinning of two different forms of fracture prevention. The first is the fracture liaison service(FLS), in which persons aged 50 years or older who have suffered a fracture are assessed and treated. The second is a stepped screening program for women aged 65 years or older, utilizing questionnaires and bone densitometry to identify those with the highest fracture risk for treatment. The FLS approach is based on indirect evidence and has not been studied in randomised studies. There is a lack of evidence for effectiveness in the younger age group of 50-65 years. A meta-analysis of three randomised studies in older women showed a 20% risk reduction of hip fractures. We suggest that FLS should focus on the group >65 years and that an additional once in a life time fracture risk screening program in women of 75-80 year should be considered.