Dilemmas in the management of osteoporosis.

Fragility fracture is the clinically apparent and relevant outcome in osteoporosis. Osteoporotic fragility fractures occur most commonly in the vertebrae, hip and wrist, and are associated with substantial disability, pain and reduced quality of life. It is estimated that more than 2 million women have osteoporosis in England and Wales. In the UK, there are over 300,000 fractures each year, causing severe pain and disability to individuals at an estimated annual cost to the NHS of over £1.73 billion. As a result of increased bone loss after the menopause in women, and age-related bone loss in both women and men, the prevalence of osteoporosis increases markedly with age, from 2% at 50 years to more than 25% at 80 years in women. Despite the development of a number of guidelines for the diagnosis and treatment of osteoporosis, management of the condition is not straightforward. Here we provide a reminder of some specific dilemmas facing generalists in regards to the management of osteoporosis, including diagnosis and investigation for reversible secondary causes; the effectiveness and duration of pharmacological management with oral bisphosphonates; and the role of calcium and vitamin D. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.