Monitoring osteoporosis treatment

Bone mineral density (BMD) measurements are recommended in some guidelines for monitoring osteoporosis treatment. However, evidence to support this approach is lacking, since treatment-induced changes in bone density may take up to 3 years to detect and do not predict fracture reduction. Biochemical markers of bone turnover have potential for monitoring since they change rapidly in response to treatment and are more predictive of fracture reduction, but variability of their measurement reduces their value in clinical practice. Neither approach has been shown to improve adherence to therapy. By contrast, there is evidence that discussion with a health-care professional improves treatment adherence, regardless of feedback about monitoring tests. At present, there is no justification for the use of bone-density measurement or bone-turnover markers in routine monitoring, but patients should be fully informed about their treatment and provided with the opportunity to discuss treatment-related issues with a health-care professional. (C) 2009 Elsevier Ltd. All rights reserved.