The literature search for this project started with the results of a literature search performed by the National Osteoporosis Foundation (Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis), published in 1998 and including literature through 1996. We searched subsequent literature. The search was conducted prospectively using the major key words of: osteoporosis (or osteoporosis, postmenopausal); osteopenia; either hip fractures or spinal fractures with either osteoporosis or osteopenia; English language; cost savings, cost and cost analysis; sensitivity and specificity, false negative reactions, false positive reactions, likelihood functions, sensitivity, diagnosis; clinical protocols, physician's practice patterns, algorithms, outcome and process assessment (health care), consensus development conferences, practice guidelines, guideline; clinical trials, clinical trials phase IV, controlled clinical trials, multicenter studies, randomized controlled trials, cohort studies. Specific searches were performed for (1) postmenopausal osteoporosis (1996-99), for (2) steroids (1994-99), and for organ transplantation, transplantation (1990-99) with each of the following: densitometry x-ray, bone density, absorptiometry photon; calcium, calcium carbonate, calcium citrate; Vitamin D; estrogens, progestational hormones, androgens, estrogen replacement therapy; diphosphonates; tamoxifen; piperidines; calcitonin; exercise; accident prevention. Searches were also performed for men, male; alternative medicine, isoflavones; alkaline phosphatase, hydroxyproline,
osteocalcin, bone marker, bone and bones; osteopenia (1990-99).
The search was conducted in components each keyed to a specific causal link in a formal problem structure (available upon request). The search was supplemented with very recent clinical trials known to expert members of the panel. Negative trials were specifically sought. The search was a single cycle.