Therapeutic strategies in the prevention of hip fracture with drugs affecting bone metabolism.

This is increasing evidence that interventions with drugs affecting bone metabolism decrease the risk of hip fracture. The use of such agents is increasing in Europe, and there is a need to develop the strategies for optimum means of intervention. This paper assesses the impact of the increasing use of such agents on hip fracture outcome using several sets of assumptions. Since hip fractures occur largely after the age of 70 years, intervention directed at this age has a significant impact on hip fractures prevented. Indeed, the gains are greater if the effects of a 5-year treatment wear off once treatment has stopped. The targeting of intervention to those with the lowest values of bone mineral density increases the efficiency of intervention on hip fracture outcome by 70-140%, depending on the gradient of risk associated with decreasing bone mineral density.