Human immunodeficiency virus infection or AIDS Hematologic disorders (hemophilia, leukemia and lymphomas, monoclonal gammopathies, multiple myeloma, sickle cell disease, thalassemia) Gastrointestinal disorders (celiac disease, gastric bypass, inflammatory bowel disease, malabsorption, pancreatic insufficiency, primary biliary cirrhosis) Screen for osteoporosis in women 65 years and older, and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factorsĬurrent evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in menĬentral nervous system disorders (e.g., epilepsy, multiple sclerosis, Parkinson disease, spinal cord injury, stroke)Įndocrine/metabolic disorders (adrenal insufficiency, athletic amenorrhea, Cushing syndrome, hemochromatosis, homocystinuria, primary hyperparathyroidism, hyperprolactinemia, hyperthyroidism, primary or secondary hypogonadism, premature menopause, thyrotoxicosis, type 1 diabetes mellitus) United Kingdom National Osteoporosis Guideline Group A5 (2009)Ĭase finding for BMD assessment is based on risk factor assessment and comparison of risk to age- and sex-specific fracture probabilities Repeat BMD testing in one to three years and reassess risk in moderate- and high-risk groups Vertebral fracture or osteopenia on radiography Low body weight ( 10% of weight at 25 years of age) Low body weight ( 3 months cumulative therapy in past year), high-risk medication use, hypogonadism or premature menopause (age 50 years): Other perimenopausal or postmenopausal women with risk factors for osteoporosis if willing to consider pharmacologic interventions:Įxcessive consumption of alcohol (> 2 drinks per day for women) Patients at increased risk of secondary osteoporosis (e.g., rheumatoid arthritis) Starting or taking long-term systemic glucocorticoid therapy (≥ 3 months) With osteopenia identified radiographically With a history of fracture(s) without major trauma after 40 to 45 years of age In patients who cannot tolerate or whose symptoms do not improve with bisphosphonate therapy, teriparatide (Forteo) and denosumab (Prolia) are effective alternative medications to prevent osteoporotic fractures.Īmerican Association of Clinical Endocrinologists A1 (2010) Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.Ī fall risk assessment should be performed and a multicomponent exercise program and smoking cessation should be recommended to decrease fracture risk in individuals 65 years and older with osteoporosis or a history of vertebral fracture.īisphosphonates should be used as first-line pharmacologic treatment for osteoporosis. Women younger than 65 years should be screened for osteoporosis if the estimated 10-year fracture risk equals or exceeds that of a 65-year-old white woman with no risk factors. The need for follow-up bone mineral density testing in patients receiving treatment for osteoporosis is uncertain.Īll women 65 years and older should be screened for osteoporosis with dual energy x-ray absorptiometry of the hip and lumbar spine. Raloxifene, teriparatide, and denosumab are alternative effective treatments for certain subsets of patients and for those who are unable to take or whose condition does not respond to bisphosphonates. Clinicians should consider discontinuing bisphosphonate therapy after five years in women without a personal history of vertebral fractures. First-line treatment to prevent fractures consists of fall prevention, smoking cessation, moderation of alcohol intake, and bisphosphonate therapy. In patients with newly diagnosed osteoporosis, suggested laboratory tests to identify secondary causes include serum 25-hydroxyvitamin D, calcium, creatinine, and thyroid-stimulating hormone. Preventive Services Task Force found insufficient evidence to recommend screening for osteoporosis in men other organizations recommend screening all men 70 years and older. Although guidelines are lacking for rescreening women who have normal bone mineral density on initial screening, intervals of at least four years appear safe. Preventive Services Task Force recommends using dual energy x-ray absorptiometry to screen all women 65 years and older, and younger women who have an increased fracture risk as determined by the FRAX Fracture Risk Assessment Tool. The impact of fractures includes loss of function, significant costs, and increased mortality. Osteoporosis-related fractures affect approximately one in two white women and one in five white men in their lifetime.
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