Treat to target for osteoporosis: another step forward

Monitoring treatment effects can inform both the physician and patient whether the medication has achieved its anticipated targets. There are several variances between patients cohorts included in clinical trials and subjects managed in standard clinical setting. Therefore, defining a patient as a "responder" or "non-responder" to management might not be applicable in day to day care, in particular in patients suffering from chronic diseases. So far, in patients receiving treatment for osteoporosis, there is no clear guidance on when the fracture risk has been reduced to an acceptable low level. As a consequence, some patients at low risk for fracture may have continued their treatment for longer periods than necessary, whereas others at high risk for fracture may have their treatment stopped whilst the continuation of the same medication or a change to a more potent therapy might be of value. In many specialties, goal-directed treating to target is already the standard and the time has come for goal-directed management of osteoporosis. Adopting treat-to-target approach in osteoporosis has the prospective of developing the patients' care, plummeting the osteoporotic fractures burden, in addition to having a positive cost-effectiveness impact. This article aims at discussing the potential utility of "treat-to-target" approach for osteoporotic patients management in standard clinical practice. It also includes a suggested algorithm for long term osteoporosis treatment as well as post-drug holiday management based on "treat to target" strategy.