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. 2023 Jun 20;9(2):45–52. doi: 10.1016/j.afos.2023.06.001

Table 8.

Management according to fracture risk.

Recommendations for Management Grading of recommendations Quality of evidence
Low to moderate fracture risk
Do not recommend osteoporosis drug III D
Adequate calcium and vitamin D intake and lifestyle modification IIa B
Re-evaluate fracture risk in 2–5 years IIb D
High fracture risk
Bisphosphonate as the initial treatment, and denosumab as an alternative treatment I A
If inappropriate for bisphosphonate or denosumab, consider other antiresorptive drugs I A
If inappropriate for antiresorptive drugs, consider calcium and vitamin D supplements, lifestyle modification, and fall prevention I B
Monitoring treatment response
  • -

    New fragility fracture

  • -

    BMD measurement at 1–2 years after starting therapy

I A
Very high fracture risk
Sequential therapy
  • -

    Teriparatide for 2 years → bisphosphonate or denosumab

  • -

    Romosozumab for 1 year → bisphosphonate or denosumab

I A
If unable to use an osteoanabolic drug, consider an injectable antiresorptive drug (zoledronic acid or denosumab) I A
If unable to use an injectable antiresorptive drug, consider oral bisphosphonate I A
Monitoring treatment response
  • -

    New fragility fracture

  • -

    BMD measurement at 1 year after starting therapy

I A