Evidence-based osteoporosis

Osteoporosis is an increasingly common disease in the developed world bringing considerable morbidity to patients and financial dilemma to national health services. By employing the rules of evidence-based medicine the Scottish Intercollegiate Guideline Network has developed clinical guidelines for »The Management of Osteoporosis«. These guidelines contain 36 specific recommendations, mainly in the areas of diagnosis and been assisted by having a wide cross-section of interests, including patients, in the guideline development group; by extensive consultation; and by the inclusion of good practice points in areas where hard evidence is lacking. Biochemical markers of bone turnover will eventually play an important part in monitoring the response to therapy and, perhaps, in assessing fracture risk. However, the production of hard evidence for their role is hampered by the wide and changing repertoire of available markers; by their biological variability in normal and osteoporotic subjects; and by the lack of standard protocols for the use and comparison of markers. The central role of the laboratory medicine service and the training of Clinical Chemists places the profession in an ideal position to taking a leading role in multidisciplinary evidence-based medicine projects.