Review of guidelines for testing and treatment of osteoporosis

Our knowledge on diagnosis and treatment of osteoporosis has steadily increased during the past decade. Several guidelines on treatment of osteoporosis are now available. Although there is heterogeneity in these recommendations, there are several common suggestions found. Case finding is advocated in all; however, it is generally acknowledged that further research is necessary to evaluate the effectiveness of case-finding strategies. Dual-energy x-ray absorptiometry is considered the gold standard for diagnosis of osteoporosis. The use of the T score is different for diagnostic purposes and for treatment decisions. Other bone measurement techniques are proposed as risk evaluation or as alternatives when dual-energy x-ray absorptiometry is not available. Bone markers are not considered for evaluation in clinical practice. Treatment options include general measures on lifestyle, fall prevention, calcium and vitamin D supplements, hormone therapy, raloxifene, and bisphosphonates. Consistent recommendations are found mostly for raloxifene in the prevention of vertebral fractures and for alendronate and risedronate in the prevention of vertebral and nonvertebral fractures, including hip fractures.