Abstract
Osteoporosis is a symptomless disease resulting in an increased risk of low-trauma fracture, common fracture sites including the wrist, spine and hip. Comprehensive clinical guidelines for the diagnosis and treatment of osteoporosis in adults include those produced by the UK National Institute for Health and Care Excellence, National Osteoporosis Guideline Group and Scottish Intercollegiate Guideline Network. However, older people bear the greatest health burden from osteoporosis, and the applicability to this age group of guidelines, clinical risk factors and bone mineral density (BMD) measurements must be considered. Fracture risk estimation can be used to identify patients at highest fracture risk, with or without BMD, and treatment targeted at those most likely to benefit. Lifestyle factors, including exercise and diet, are important in fracture prevention, although the evidence to support these in treating osteoporosis needs further assessment. Ultimately, pharmacological therapy is likely to be necessary in those at greatest fracture risk. In approaching treatment decisions, the benefits and risks of therapy must be balanced to reach a shared care agreement, with patients (and their carers). The benefits of treatment are generally likely to outweigh the risks of adverse outcomes for patients at high risk of osteoporotic fracture.