Overdiagnosis of osteoporosis: fact or fallacy?

No one would deny that, as in many fields of medicine, there are gaps in the evidence or that current practice can be improved. Indeed, we know that the majority of elderly people who suffer a hip fracture are not assessed for osteoporosis or offered treatment in the form of lifestyle advice, falls counselling or bone protective therapy [8, 9]. These individuals are at high risk of further fractures and the proven anti-fracture efficacy of pharmacological interventions in this situation provides a strong rationale for their use in secondary prevention. Prevention of the first fracture is another important but more difficult goal, and the efficacy of pharmacotherapy for the primary prevention of fracture has been less well studied. In much of their analysis, Jrvinen et al. fail to make the critical distinction between primary and secondary prevention and by combining figures from studies of both in their meta-analysis, they arrive at a NNT for hip fracture that is too high and meaningless in the context of secondary prevention.