The crisis of inadequate treatment in osteoporosis.

The number of fractures related to osteoporosis is expected to increase dramatically in the next few decades because of an increase in the number of elderly patients at high risk of falls and fractures. Developments in the diagnosis and treatment of osteoporosis might change our strategies for management of patients with osteoporosis: the imminent risk of fracture concept, the issue of how to correctly sequence treatment, the potential effectiveness of screening, and goal-directed treatment strategies. Despite advances, few patients receive appropriate treatment for osteoporosis, even after a fracture. The crisis in the treatment of osteoporosis is related to several factors, including the fears and beliefs that patients and physicians have about the adverse effects of treatments. Strategies to address this crisis pose a considerable challenge; nonetheless, prevention of fragility fractures is within our reach. To that end, careful selection of patients at high risk of fracture, selection of the best therapeutic strategy, and accurate communication about fracture risk and bone fragility must be improved.