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Osteoporosis is a silent disease until it is complicated by fractures—fractures that can occur following minimal trauma. These fractures are common and place an enormous medical and personal burden on individuals during aging and a major economic toll on the nation.

Osteoporosis can be prevented, diagnosed and treated before any fracture occurs. Importantly, even after the first fracture has occurred, there are effective treatments to decrease the risk of further fractures. Prevention, detection and treatment of osteoporosis should be a mandate of primary care providers.

Since NOF first published the Guide in 1999, it has become increasingly clear that many patients are not being given appropriate information about prevention; many patients are not having appropriate testing to diagnose osteoporosis or establish osteoporosis risk; and, once diagnosed (by testing or by the occurrence of a fracture), too many patients are not being prescribed any of the FDA-approved, effective therapies. This Guide offers concise recommendations regarding prevention, risk assessment, diagnosis and treatment of osteoporosis in postmenopausal women and men age 50 and older. It includes indications for bone densitometry and fracture risk thresholds for intervention with pharmacologic agents. The absolute risk thresholds at which consideration of osteoporosis treatment is recommended were guided by a cost-effectiveness analysis.