Western Osteoporosis Alliance Clinical Practice Series: Treat-to-Target for Osteoporosis

Am J Med. 2019 Nov;132(11):e771-e777. doi: 10.1016/j.amjmed.2019.04.044. Epub 2019 May 29.


Patients often start treatment to reduce fracture risk because of a bone mineral density T-score consistent with osteoporosis (≤ -2.5). Others with a T-score above -2.5 may be treated when there is a history of fragility fracture or when a fracture risk algorithm categorizes them as having a high risk for fracture. It is common to initiate therapy with a generic oral bisphosphonate, unless contraindicated, and continue therapy if the patient is responding as assessed by stability or an increase in bone mineral density. However, some patients may respond well to an oral bisphosphonate, yet remain with an unacceptably high risk for fracture. Recognition of this occurrence has led to the development of an alternative strategy: treat-to-target. This involves identifying a biological marker (treatment target) that represents an acceptable fracture risk and then initiating treatment with an agent likely to reach this target. If the patient is on a path to reaching the target with initial therapy, treatment is continued. If it appears the target will not be reached with initial therapy, treatment is changed to an agent more likely to achieve the goal.

Keywords: Bone mineral density; Bone turnover markers; Goal; Osteoporosis; Treatment target.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Biomarkers / analysis*
  • Bone Density
  • Bone Density Conservation Agents / therapeutic use*
  • Humans
  • Osteoporosis / drug therapy*
  • Osteoporotic Fractures / prevention & control*
  • Patient Selection


  • Biomarkers
  • Bone Density Conservation Agents