Indications for Pharmacologic Treatment of Osteoporosis and Osteopenia

Consider FDA-approved medical therapies in postmenopausal women and men aged 50 years and older, based on the following:

1. A hip or vertebral (clinical or morphometric) fracture
2. Osteoporosis: T-score ≤ -2.5 at the femoral neck or spine after appropriate evaluation to exclude secondary causes.
3. Osteopenia or Low bone mass (T-score between -1.0 and -2.5 at the femoral neck or spine) and a 10-year probability of a hip fracture ≥ 3% or a 10-year probability of a major osteoporosis-related fracture ≥ 20% based on the US-adapted WHO algorithm
4. Clinicians judgment and/or patient preferences may indicate treatment for people with 10-year fracture probabilities above or below these levels

Consider referring premenopausal women or men under 50 to an endocrinologist.

Treat all patients after a hip fracture or vertebral fracture with bisphosphonates, regardless of bone mineral density, unless a contraindication exists.

Reference

https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9, Accessed 10/2017