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
|
I | A |
Very high fracture risk | ||
Sequential therapy
|
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
|
I | A |