Monitoring osteoporosis therapies

Postmenopausal osteoporosis (PMO) is a progressive disease of bone loss, fractures, or both. The progression of osteoporosis leads to increased mortality and morbidity and impairs quality of life. There are effective treatments that prevent bone loss, increase bone strength, and reduce fracture risk. Improvement in persistence and adherence to therapy leads to better clinical outcomes. The management of PMO is facilitated by measuring surrogate markers of the efficacy of PMO treatments: 1) bone mineral density, 2) bone turnover markers, and 3) assessment of spinal integrity by vertebral fracture assessment by dual-energy x-ray absorptiometry. Appropriate use of markers measures the patient's baseline fracture risk and monitors response to treatments. Clinicians must interpret markers in the context of a patient's fracture risk and determine the effectiveness of therapy. Integrating these markers enhances overall patient care. The surrogate markers help the clinician to achieve the goal of managing PMO; attempting to manage PMO without markers reduces the clinical management to guesswork.