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However, all these three notions can be disputed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Pathophysiology<\/jats:title><jats:p>Most fracture patients have fallen, but actually do not have osteoporosis. A high likelihood of falling, in turn, is attributable to an ageing\u2010related decline in physical functioning and general frailty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Screening<\/jats:title><jats:p>Currently available fracture risk prediction strategies including bone densitometry and multifactorial prediction tools are unable to identify a large proportion of patients who will sustain a fracture, whereas many of those with a high fracture risk score will not sustain a fracture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Treatment<\/jats:title><jats:p>The evidence for the viability of bone\u2010targeted pharmacotherapy in preventing hip fracture and other clinical fragility fractures is mainly limited to women aged 65\u201380\u00a0years with osteoporosis, whereas the proof of hip fracture\u2010preventing efficacy in women over 80\u00a0years of age and in men at all ages is meagre or absent. Further, the antihip fracture efficacy shown in clinical trials is absent in real\u2010life studies. Many drugs for the treatment of osteoporosis have also been associated with increased risks of serious adverse events. There are also considerable uncertainties related to the efficacy of drug therapy in preventing clinical vertebral fractures, whereas the efficacy for preventing other fractures (relative risk reductions of 20\u201325%) remains moderate, particularly in terms of the low absolute risk reduction in fractures with this treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.12366","type":"journal-article","created":{"date-parts":[[2015,3,24]],"date-time":"2015-03-24T23:02:09Z","timestamp":1427238129000},"page":"662-673","source":"Crossref","is-referenced-by-count":44,"title":["Osteoporosis: the emperor has no clothes"],"prefix":"10.1111","volume":"277","author":[{"given":"T. L. 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