The judicious use of resources in the managed care setting requires that outcomes assessment be used in selecting the most cost-effective alternative strategies for preventing and treating diseases. Osteoporosis has major medical and economic costs and consequences for society, yet the most effective strategies to pursue in reducing these costs and consequences are uncertain. Selecting appropriate screening, preventive, and therapeutic strategies will require careful evaluation of data from clinical trials and from outcomes research in determining the most appropriate course of action. These issues represent a major challenge for the decision maker in the managed care setting.