Approach to Personalizing the Treatment of Osteoporosis

Despite the availability of multiple highly effective pharmacologic therapies for osteoporosis, fracture rates in the United States have plateaued or increased in recent years. At the same time, individuals with osteoporosis are exposed to an abundance of digital health information and frequently seek guidance on nutrition, exercise, and other lifestyle strategies to improve bone health. Many endocrinologists, however, may have limited time or expertise to address these questions comprehensively during routine clinical encounters. Current clinical practice guidelines provide valuable direction on selecting pharmacotherapy based on fracture risk, yet they offer limited guidance on how to personalize treatment plans by integrating patient values, beliefs, and preferences. The aim of this manuscript is to equip clinicians with practical, preference-sensitive strategies to address common concerns raised by postmenopausal women with osteoporosis, including evidence-based guidance on nutrition and on safe, effective resistance, impact, and balance-focused exercises for bone health and fall prevention. We also outline suggested approaches for responding to common concerns among patients who are reluctant to initiate pharmacologic therapy. Through two illustrative cases, we highlight how clinicians can integrate pharmacologic options with evidence-based lifestyle guidance and engage patients in shared decision making to develop individualized, goal-concordant care plans. Our goal is to provide clinicians with tools that support more effective, patient-centered conversations and ultimately improve the quality of osteoporosis care.