Table 2.

Criteria for Identifying Women for Treatment under Each Strategy^*

NOF strategy

CAROC-based Canadian strategy†

At least one of the following” Prior hip fracture Prior vertebral fracture BMD T-score ≤−2.5 at the femoral neck, total hip, or lumbar spine by dual-energy X-ray absorptiometry BMD T-score between −1 and −2.5 in addition to having 10-year FRAX-predicted fracture risk of: ≥3% for hip fracture and/or ≥20% for major osteoporotic fracture‡

At least one of the following: High 10-year predicted major osteoporotic fracture risk (>20%) based on age and femoral neck BMD T-score (CAROC risk tables) Prior fragility fracture of hip Prior fragility fracture of spine More than one fragility fracture (excluding head/neck, hands/feet, ankle) Moderate 10-year predicted major osteoporotic fracture risk (10%−20%) based on age and femoral neck BMD T-score (CAROC risk tables) plus at least one additional factor: Previous wrist fracture if T-score ≤−2.5 Lumbar spine T-score much lower than femoral neck T-score§ Aromatase inhibitor therapy Long-term or repeated glucocorticoid use other than the “high risk” pattern noted in screening strategy (see Table 1) ≥2 falls in past 12 months Other disorders strongly associated with osteoporosis, rapid bone loss, or fractures**

^*NOF denotes National Osteoporosis Foundation; CAROC denotes Canadian Association of Radiologists and Osteoporosis Canada; BMD denotes bone mineral density; FRAX denotes fracture risk assessment tool

^†Fragility fracture after age 40 or recent prolonged glucocorticoid use increases the CAROC-based risk by one category (i.e. from low to moderate or moderate to high risk).

^‡Major osteoporotic fracture includes clinical spine, forearm, hip or humerus fracture

^§We operationalized this by using ≥1.0 SD discrepancy.

^**See the disorders listed in Table 1.