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