When we treat postmenopausal women with osteoporosis we are treating elderly patients with multiple comorbid problems and a finite lifespan. For instance , many of these patients have gastric problems and difficulty with ingesting pills. Many of these patients are on polypharmacy and do not want additional pills. Thus, the treatment of these patients frequently depends on factors outside of their DEXA scores or Frax scores, such as their insurance coverage and the patients ability to tolerated additional pills with hypothetical benefit.