It is also clear from the US Surgeon General’s Report on Bone Health and Osteoporosis [17] that public health efforts to educate patients about risk factors as well as patients taking personal responsibility for their own health issues will be needed to help those at risk recognize their susceptibility to problems such as future fractures. Strengths and limitations Our intention in GLOW was to include subjects who were broadly representative of this website women aged 55 and older by attempting to enlist all women in this age group who were active patients in each physician’s practice. As a non-randomized, observational, practice-based study, however,

GLOW is subject to biases in both the selection of physicians and the sampling and recruitment of patients. It is possible that participants would have greater interest in bone health issues and seek information, screening, and treatment more actively. Physicians who agreed to participate may not be representative of all physicians in a given area with respect to osteoporosis recognition and management. As increasing age is acknowledged to be the single most predictive risk of fracture, we attempted to mitigate its

confounding influence by asking women to rate their personal risk in comparison to women of their own age. This strategy appeared to operate successfully, as the age-stratified analyses shown in Table 1 indicated that distributions of perceived risk were similar among women across Cyclic nucleotide phosphodiesterase age groups. Possible confusion among subjects between

rheumatoid and other types of arthritis prompted us to drop the characteristic VX-680 research buy from our analysis. We also considered only current use of the glucocorticoids prednisone and cortisone as a risk factor where FRAX considers “ever use” a risk. Reports that have critically assessed increased susceptibility to PRI-724 mouse fracture risk and the timing of glucocorticoid use suggest that current use is the most important predictor and that once use is discontinued, fracture susceptibility returns to baseline levels [18]. Aromatase inhibitors, while not specifically suggested as risk factors in the FRAX algorithm, were included because of their antiestrogenic properties and their association with bone loss and elevated risk of fractures in postmenopausal women [19]. Conclusion Our data document, in a population of over 60,000 postmenopausal women from ten countries in North America and Europe, as well as Australia, that there is a consistent under-appreciation of personal risk factors for osteoporosis and fracture. Tools for diagnosis and risk assessment are widely available, as are safe and effective treatments when indicated, but if women fail to appreciate their own risks there will inevitably be a barrier to them receiving appropriate assessment and management. Improved education of both physicians and postmenopausal women about osteoporosis risk factors is needed.