Abstract: Guidelines concerning the definition of failure of therapies used to reduce the risk of fracture are provided. Introduction: This study aims to provide guidelines concerning the definition of failure of therapies used to reduce the risk of fracture. Methods: A working group of the Committee of Scientific Advisors of the International Osteoporosis Foundation was convened to define outcome variables that may assist clinicians in decision making. Results: In the face of limited evidence, failure of treatment may be inferred when two or more incident fractures have occurred during treatment, when serial measurements of bone remodelling markers are not suppressed by anti-resorptive therapy and where bone mineral density continues to decrease. Conclusion: The provision of pragmatic criteria to define failure to respond to treatment provides an unmet clinical need and may stimulate research into an important issue.

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