[Medical treatment of postmenopausal osteoporosis]

The primary objective of postmenopausal osteoporosis treatment is to reduce the risk of fragility fracture. Therefore, the necessary first step is to identify patients at high risk of fracture to treat them in the most efficient manner In case of patients with a so-called severe fracture including hip fracture, vertebral and humeral fracture, characterized by an increased risk of mortality in the following years, it is mandatory to treat osteoporosis. In the other cases with or without fracture, the decision will rely on clinical fracture risks and the result of densitometry assessment. The treatment will be prescribed for a first period of 5 years and then reassessed for deciding whether the treatment will be continued or interrupted. Reassessments will then be performed regularly. When treating is decided, the choice between the different drugs is based on their respective ability to reduce the risk of vertebral or non-vertebral fracture, their potential extra-skeletal benefits, tolerance and contra-indications as well as administration conditions which have an impact on adherence to treatment. The latter is important to obtain the expected efficacy of the treatment and it has to be clearly explained to the patient and controlled during follow-up.