Defining treatment failure in severe osteoporosis.

The management of postmenopausal osteoporosis has benefited from the recent introduction of several new drug classes and is now well standardized. However, none of the available osteoporosis drugs completely abolishes the occurrence of fractures. Therefore, criteria are needed to determine when the occurrence of a fracture during treatment indicates failure to respond to the drug. Such criteria would improve patient management. A panel of national osteoporosis experts was convened to discuss data from a literature review on severe osteoporosis (Osteoporosis DIagnosis and Surveillance of SEvErity, ODISSEE). The experts reached a consensus that "an inadequate response to treatment for postmenopausal osteoporosis is the occurrence, in a patient with severe osteoporosis, adequate calcium and vitamin D intakes, and good treatment adherence, of any of the following: incident major fracture within the first treatment year, more than one minor insufficiency fracture, or a bone mineral density decrease by at least the smallest significant amount (0.03 g/cm(2)) after 5 years or earlier in the event of a minor fracture".