Prevention of hip fractures in older women: a population-based perspective.

We now have several means of reducing the risk of fractures. Expert medical treatment of individual patients by modifying risk factors and appropriately prescribing effective supplements and drugs substantially reduces the patient's fracture risk but is not commonly provided to patients. At the moment, women at the greatest risk of fracture appear to be only slightly more likely to receive treatment that reduces fracture risk than women who are at low risk. This strategy seems likely to miss the vast majority of women who account for most of the hip fractures. On the other hand, the impact of strategies to reduce rates of hip fractures in populations critically depends on the reach of the program and adherence with treatment. It is not yet clear that effective population based programs will be affordable or cost-effective. To have a substantial impact on the rates of fractures in populations, we will need to be as energetic and clever in developing these strategies during the next decade as we have been in developing screening devices and new pharmaceuticals during the past one.