The 2008 American College of Physicians (ACP) recently updated its recommendations on treatment of low bone density and osteoporosis to prevent fractures in men and women. This guideline is endorsed by the American Academy of Family Physicians. Key points are as follows:

• ACP recommends that clinicians offer pharmacologic treatment to reduce the risk for hip and vertebral fractures in women who have known osteoporosis.
• ACP recommends that clinicians treat osteoporotic women with pharmacologic therapy for 5 years.
• ACP recommends that clinicians offer pharmacologic treatment with bisphosphonates to reduce the risk for vertebral fracture in men who have clinically recognized osteoporosis.
• ACP recommends against bone density monitoring during the 5-year pharmacologic treatment period for osteoporosis in women.
• ACP recommends against using menopausal estrogen therapy or menopausal estrogen plus progestogen therapy or raloxifene for the treatment of osteoporosis in women.
• ACP recommends that clinicians should make the decision whether to treat osteopenic women aged ≥65 years who are at a high risk for fracture based on a discussion of patient preferences, fracture risk profile, and benefits, harms, and costs of medications.