Pharmacological treatment in osteoporosis: When to start?

When should we start pharmacological treatment of osteoporosis?

Alexandra Papaioannou, MD: That is the million dollar question: When is the right time where the benefits outweigh the harms? Certainly internationally most experts would agree that those patients that are high-risk would score either 20% on their major osteoporotic risk or 3% risk for a hip fracture in 10 years on the fracture risk assessment tool (FRAX). Generally, this is the older population and numbers needed to treat are actually very low: <20 to prevent a spine fracture.