Diagnosis and management of osteoporosis in postmenopausal women: Clinicalguidelines

The authors, all physicians involved in clinical research on bone and pract icing clinicians, propose practical guidelines for identifying persons with osteoporosis or those at high risk of developing the disease and for manag ing patients who may benefit from therapy. These guidelines are based on an analysis of peer-reviewed articles published before November 1998. A flowc hart of women who might benefit from treatment is provided, including clini cal presentation (recent fracture of the spine, hip, or other bone or no fr acture; risk factors for osteoporosis); relevant investigations (bone miner al density measurement and laboratory tests required for the differential d iagnosis); and therapeutic management (general measures such as calcium and vitamin D supplementation and specific pharmacologic interventions such as estrogen, bisphosphonates, intranasal calcitonin, raloxifene, fluoride sal ts, and other compounds that have been assessed in randomized clinical tria ls). The strongest evidence for antifracture efficacy (reduction of vertebr al and nonvertebral fracture risk) was observed with alendronate.