| Very high risk: if one or more of the following |
| • Major osteoporotic fracture in the last 12-24 months |
| • Multiple major osteoporotic fractures |
| • Fracture during osteoporosis treatment |
| • Fracture during treatment with harmful drugs for bone |
| • T-score <-3.5 |
| • T-score <-2.5 and FRAX: 10-year major osteoporotic fracture risk >30%, hip fracture risk >4.5% |
| Treatment |
| • Anabolic agents: teriparatide, abaloparatide, romosozumab |
| • Antiresorptive agents: denosumab, zoledronic acid |
| • Calcium, vitamin D, modification of lifestyle and prevention of falls |
| High risk: if any of the following |
| • Hip or recent spine fracture |
| • T-score <-2.5 and one vertebral fracture |
| • T-score <-3.0 |
| • Continuing treatment with harmful drugs for bone and T-score <-2.5 |
| • Age >75 years and T-score <-2.5 |
| • T-score <-2.5 and FRAX: 10-year major osteoporotic fracture risk >20%, hip fracture risk >3% Treatment
|
| • Anabolic agents: teriparatide, abaloparatide, romosozumab |
| • Antiresorptive agents: alendronate, risedronate, zoledronic acid, denosumab |
| • Calcium, vitamin D, modification of lifestyle and prevention of falls |
| Moderate risk: if any of the following |
| • T-score <-2.5 and no fracture |
| • T-score between -1 and -2.5 and FRAX: 10-year major osteoporotic fracture risk >20%, hip fracture risk >3% Treatment
|
| • At any age: alendronate, risedronate |
| • If the patient is <65 years old: raloxifene, ibandronate, hormone-replacement therapy |
| • Calcium, vitamin D and modification of lifestyle |
| Low risk: if any of the following |
| • Age <65 and T-score >-2.5 and no major risk factors |
| • T-score between -1 and -2.5 and FRAX: 10-year major osteoporotic fracture risk <20%, hip fracture risk <3% Treatment |
| • Calcium, vitamin D and modification of lifestyle |
| FRAX: Fracture Risk Assessment Tool. |
