Selecting patients for osteoporosis therapy.

Our goal globally is to better identify individuals at risk for osteoporotic fracture so that those at high risk can be treated and unnecessary treatment for those at low risk can be avoided. Bone mineral density (BMD) information is not sufficient to identify all patients at high risk. Approximately half of patients in the community with fractures do not have osteoporosis by the 1994 World Health Organization BMD criteria. Furthermore, BMD information based on central DXA is not easily accessible worldwide. The use of clinical risk factors with or without BMD information will improve gradient of risk and help us better identify patients at high risk for fracture. The clinical risk factors identified can be integrated to predict a 10-year absolute risk or probability of fracture. Intervention thresholds based on absolute risk will be defined regionally based on each nation's ability and willingness to pay.