A low trauma fracture is a hallmark of the condition and high-dose corticosteroid treatment is associated with a high risk of osteoporosis and justifies intervention. We have effective interventions that have been shown in randomised controlled trials to prevent fracture of the vertebrae and hip, principally in those at risk with low bone mass or previous fracture. The cost-benefit ratio must be debated by society and different conclusions may be reached as to how much one is prepared to spend to prevent a fracture in different countries with competing priorities. We are entering the Bone and Joint Decade, the aim of which is to improve the health-related quality of life of those with musculoskeletal disorders. The effective prevention of osteoporosis is a necessity, not a luxury, yet there is a danger that nothing will happen and the burden will continue to rise whilst there is uncertainty about how to prevent osteoporosis, how to identify who to treat, and what treatments are cost effective.
Education is needed of the public and of all health professionals on what can be done and how.
These strategies need, as emphasized by Sisson de Castro, to be put into clear guidelines. The effectiveness of such strategies, like those being used in Hungary, needs to be evaluated in routine clinical settings and this requires better data collection on fractures and assessment of their impact on quality of life. In this way, effective strategies can then be developed that are appropriate to each country, disseminated, implemented and evaluated for preventing fracture and reducing the enormous and increasing burden of disease due to osteoporosis. Brussels, European Community, 1998.