If you've followed the advice from our last two newsletters, and have decided to treat a patient who is at risk for fracture, it's time to think about effective treatments and potential harms in treatments. Osteoporosis is a constantly changing picture of a number of therapies with many sources of recommendations and guidelines. Today, we look at two sources of information that hopefully offer an unbiased synthesis of current data:

McMaster University, via their Optimal Aging Portal, recently did a systematic review of 53 studies and found reliable evidence that vitamin D with calcium taken regularly slightly reduces the chance of hip and other fractures in older men and women, whether they live in the community or institutional settings. Read the review for yourself in our Quick Links section.

The NNT (Number-Needed-to-Treat) Group have developed a framework and rating system to evaluate therapies based on their patient-important benefits and harms. Below are their findings for use of bisphosphonates in post-menopausal women:

• NNT gives a green rating (benefit > harms) to using bisphosphonates for fracture prevention in post-menopausal women with prior fractures or very low bone density (view our Quick Links for the full review).

• However, NNT gives a red rating (no benefit found) for using bisphosphonates in post menopausal women without prior fracture (view our Quick Links for the full review).

Both sites have reviews on a range of topics, with detailed references and are worth a browse!