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A broader strategy for osteoporosis interventions

Nature Reviews Endocrinology volume 16, pages 333–339 (2020)Cite this article

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Abstract

Approximately 50% of women experience at least one bone fracture postmenopause. Current screening approaches target anti-fracture interventions to women aged >60 years who satisfy clinical risk and bone mineral density criteria for osteoporosis. Intervention is only recommended in 7–25% of those women screened currently, well short of the 50% who experience fractures. Large screening trials have not shown clinically significant decreases in the total fracture numbers. By contrast, six large clinical trials of anti-resorptive therapies (for example, bisphosphonates) have demonstrated substantial decreases in the number of fractures in women not identified as being at high risk of fracture. This finding suggests that broader use of generic bisphosphonates in women selected by age or fracture risk would result in a reduction in total fracture numbers, a strategy likely to be cost-effective. The utility of the current bone density definition of osteoporosis, which neither corresponds with who suffers fractures nor defines who should be treated, requires reappraisal.

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Fig. 1: The effect of zoledronate treatment on fracture risk in osteopenia.

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Authors and Affiliations

  1. Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Ian R. Reid

  2. Auckland District Health Board, Auckland, New Zealand

    Ian R. Reid

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Correspondence to Ian R. Reid.

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I.R.R. declares consultancy fees from Lilly, Amgen and Merck, as well as previous research funding from Merck and Amgen.

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Nature Reviews Endocrinology thanks E. Bogoch and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Reid, I.R. A broader strategy for osteoporosis interventions. Nat Rev Endocrinol 16, 333–339 (2020). https://doi.org/10.1038/s41574-020-0339-7

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