With the availability of new pharmacologic agents, the drug industry is currently pressuring the scientific and medical communities to increase drug therapy for osteoporosis. One element of this commercial campaign is to simplify the treatment decision by use of a bone mineral density (BMD) cutoff—a value 2.5 SDs below the BMD of a 30-year-old, normal person ( –2.5 t-score).

This plan is ill advised. The –2.5 t-score was developed by the World Health Organization as a diagnostic threshold for population studies to provide a benchmark for estimating the prevalence of osteoporosis in various countries. It was not intended to be the sole clinical criterion for determining drug treatment. Intervention thresholds differ from diagnostic thresholds.

Bone mineral density should not be the only criterion for drug treatment. Treatment decisions should be based on multiple clinical factors, including BMD. Further, no single BMD cutoff should be used. Bone mineral density provides a useful measure of the risk for fracture; the risk gradient approximately doubles for each 10% to 12% decrease in BMD. Physicians who plan to treat patients with osteoporosis must obtain special knowledge about interpreting bone densitometry reports and must understand the complexities of osteoporosis and its proper diagnosis and treatment. Only then can they responsibly initiate therapy and successfully manage this disorder.

These views are supported by leading members of other organizations, including the American Society for Bone and Mineral Research and the National Osteoporosis Foundation.