New Guidelines for the Prevention and Treatment of Osteoporosis

E. Michael Lewiecki, MD; Nelson B. Watts, MD


South Med J. 2009;102(2):175-179. 

In This Article

Abstract and Introduction


The World Health Organization Fracture Risk Assessment Tool (FRAX™) and the National Osteoporosis Foundation's (NOF) Clinician's Guide to Prevention and Treatment of Osteoporosis are helpful clinical tools in the management of osteoporosis. Appropriate use of these tools requires a clear understanding of their limitations as well as their benefits. Good clinical judgment should be the ultimate determinant of treatment decisions. We anticipate that further refinements to FRAX™ and subsequent updates of the NOF guide will improve their clinical utility.


Osteoporosis has been identified by the US Surgeon General as a major public health concern.[1] It is a common skeletal disease characterized by low bone strength and increased risk of fracture.[2] Fractures are associated with adverse outcomes that include acute and chronic pain, diminished quality of life, disability, high risk of future fractures, increased mortality, and substantial healthcare expenses. Despite the widespread availability of devices to measure bone density (to identify patients at risk of fracture) and approved medications that safely and effectively reduce fracture risk, osteoporosis is underdiagnosed and undertreated. Even when treatment is started, it is commonly not taken correctly or long enough to reduce fracture risk.

The National Osteoporosis Foundation (NOF), a not-for-profit US-based organization dedicated to improving patient access to high quality skeletal health care, released a long-awaited update of its clinical practice guidelines on February 21, 2008.[3] On the same day, a companion online fracture risk assessment calculator (FRAX™) from the World Health Organization (WHO) was opened for public use.[4] Figure 1 and Figure 2 show the FRAX™ home page and the risk calculator for US Caucasians, respectively.

Figure 1.

The FRAX™ home page. Permission from

Figure 2.

The risk calculator for US Caucasians. Permission from


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