Defining strategies for improving the identification and management of osteoporosis in the primary care setting.

New diagnostic and therapeutic options in postmenopausal osteoporosis have emerged in the last decade. Since all untreated postmenopausal women will exhibit a reduction in bone mineral density (BMD), the clinician's task is to identify those at a degree of risk that justifies intervention, and then supply appropriate therapy and monitoring. Various professional organizations and independent studies have furnished guidelines on when and whom to treat. But uncertainty still exists as to even such basic matters as when to measure BMD. This article considers the findings of the NOF, the USPTF, ACOG, the WHI, SOF, and especially NORA, comparing them with each other (and the WHO) for the guidance they offer. There is also discussion of the challenges of BMD measurement itself, and the benefit of consideration of other osteoporosis risk factors. Finally, the author provides a set of personal guidelines.