Table 10.
Clinical approach to managing osteoporosis in postmenopausal women and men age 50 and older
| General principles: |
| • Obtain a detailed patient history pertaining to clinical risk factors for osteoporosis-related fractures and falls |
| • Perform physical examination and obtain diagnostic studies to evaluate for signs of osteoporosis and its secondary causes |
| • Modify diet/supplements, lifestyle, and other modifiable clinical risk factors for fracture |
| • Estimate patient’s 10-year probability of hip and any major osteoporosis-related fracture using the US-adapted FRAX and perform vertebral imaging when appropriate to complete risk assessment |
| • Decisions on whom to treat and how to treat should be based on clinical judgment using this Guide and all available clinical information |
| Consider FDA-approved medical therapies based on the following: |
| • Vertebral fracture (clinical or asymptomatic) or hip fracture |
| • Hip DXA (femoral neck or total hip) or lumbar spine T-score ≤−2.5 |
| • Low bone mass (osteopenia) and a US-adapted WHO 10-year probability of a hip fracture ≥3 % or 10-year probability of any major osteoporosis-related fracture ≥20 % |
| • Patient preferences may indicate treatment for people with 10-year fracture probabilities above or below these levels |
| Consider nonmedical therapeutic interventions: |
| • Modify risk factors related to falling |
| • Referrals for physical and/or occupational therapy evaluation (e.g., walking aids and other assistive devices) |
| • Weight-bearing, muscle-strengthening exercise, and balance training |
| Follow-up: |
| • Patients not requiring medical therapies at the time of initial evaluation should be clinically re-evaluated when medically appropriate |
| • Patients taking FDA-approved medications should have laboratory and bone density re-evaluation after 2 years or more frequently when medically appropriate |
| • Vertebral imaging should be repeated if there is documented height loss, new back pain, postural change, or suspicious finding on chest X-ray, following the last (or first) vertebral imaging test or in patients being considered for a temporary cessation of drug therapy to make sure no new vertebral fractures have occurred in the interval |
| • Regularly, and at least annually, assess compliance and persistence with the therapeutic regimen |