Introduction The aim of this study was to evaluate the impact and appropriateness of treatment according to different osteoporosis guidelines (National Osteoporosis Foundation (NOF), Community of Madrid (CMA) and General Practitioners' Society (SEMERGEN)) in women over 50 years in Spain

Method Cross-sectional study conducted between 2006 and 2007 in Valencia, Spain. An age-stratified population-based random sample of 824 postmenopausal women over 50 answered a questionnaire about risk factors and anti-osteoporotic treatment, and received a lumbar spine and hip densitometry and a spine x-ray. The population impact and the appropriateness of treatment according to each guideline was evaluated.

Results The population of women over 50 who should be treated according to different guidelines would be 15.5% (95% CI 14.0 to 19.0) for CMA, 25.4% (95% CI 22.4 to 28.3) for SEMERGEN and 36.9% (95% CI 33.6 to 40.2) for NOF. These figures would be translated into 1.3 to 3.2 million women candidates for treatment in the Spanish NHS. Regarding the appropriateness of anti-osteoporotic treatment, 80%, 66% and 52% of the women treated (n=181; 21.9%) did not meet CMA, SEMERGEN and NOF criteria to be treated, respectively. Whereas 16%, 23% and 34% of untreated women (n=643; 78.0%) should receive treatment according to CMA, SEMERGEN and NOF guidelines.

Conclusions There are huge differences in the population impact of three commonly used guidelines. Appropriateness of anti-osteoporotic treatment was low due to overuse in women without indication and also because of underuse in women with criteria for treatment.