factor reduction. Patients should be counseled specifically on the importance of calcium,
vitamin D and exercise as part of any treatment program for osteoporosis. Prior to initiating
treatment, patients should be evaluated for causes of secondary osteoporosis and have BMD
measurements by central DXA, when available. An approach to the clinical assessment of
individuals at risk of osteoporosis is outlined in Table 7.
The percentage of risk reductions for vertebral and non-vertebral fractures cited below are
those cited in the FDA-approved Prescribing Information. In the absence of head-to-head trials,
direct comparisons of risk reduction of one drug with another should be avoided.
Who Should Be Considered for Treatment?
Postmenopausal women and men age 50 and older presenting with the following should be
considered for treatment:
• A hip or vertebral fracture (clinically apparent or found on vertebral imaging). There is
abundant data that patients with spine and hip fractures will have reduced fracture risk if
treated with pharmacologic therapy. This is true for patients with both low bone mass and
osteoporosis. [add all reference for pharmacologic therapy here – main trial citations}. In
patients with a hip or spine fracture, the T-score is not as important as the fracture itself in
predicting future risk of fracture and antifracture efficacy from treatment.32,33,34,35,36,37,38,39,40,41
• T-score ≤ -2.5 at the femoral neck, total hip or lumbar spine. There is abundant evidence that
patients with osteoporosis by BMD have an elevated risk of fracture and reduced fracture risk
with pharmacotherapy.42,43,44,45,46,47,48,49,50,51,52,53,54,55,56
• Low bone mass (T-score between -1.0 and -2.5 at the femoral neck or lumbar 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 U.S.-adapted WHO algorithm.
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