What is the optimal policy for osteoporosis management?

The fractures that result from osteoporosis create a huge burden for both individuals affected and for societies across the world. This is especially aggravated as population age. Optimal policy in the management of osteoporosis should provide alleviation of suffering by reducing fracture events. In most health systems the interest is in achieving this at manageable cost. An important initiative is the WHO programme to provide tools for the individualisation of fracture risk which would have similarities to the approach familiar to doctors in the management of coronary heart disease risk. With individualised fracture risk it should be possible to focus resources on fracture prevention in those people most at risk. It is then a matter for the healthcare system to provide policies which guide clinicians on how far down the gradient of risk the system care afford to resource. This is the basis for a cost-effective approach. The paper explores the factors that enable valid risk assessment to be made and the difficulties that result for clinicians if resources are limited and affect the level of intervention that might be preferred.