Goal-directed therapy is not as simple as it seems.

A case is discussed of a postmenopausal woman started on alendronate treatment based on a low T-score in the total hip (TH). Three years later, her TH score remains below -2.5, the target set by the ASBMR task force on goal-directed therapy.1 The important question at this juncture is whether she should change to a different treatment that might result in better improvement in TH bone mineral density (BMD) or if she should continue treatment with alendronate.