Management of Postmenopausal Osteoporosis

Publication Date: April 1, 2022
Last Updated: February 20, 2023

Key Points

  • Osteoporosis is a common disease that can result in bone fractures.
  • Through screening, risk assessment, and pharmacologic treatment, fractures can be prevented.
  • DEXA scans should be used for screening starting at age 65 for most women.
  • Biphosphonates are the first line therapy for patients found to be high risk patients and should be used for most postmenopausal patients
  • DEXA scan T score of ≤–2.5 gives diagnosis of osteoporosis
  • Evaluate all patients for secondary causes of bone loss before starting pharmacotherapy
  • Breast cancer patients/survivors are at high risk of osteoporosis development if they were treated with chemotherapy or aromatase inhibitors
  • Pharmacologic treatment is recommended for all patients at high risk of fracture
  • Bisphosphonates should be initial therapy for most postmenopausal patients
  • DXA testing every 1 to 3 years if patient is on pharmacotherapy until findings are stable

Diagnosis

Overview

  • Dual Energy X-Ray (DEXA) is preferred method
    • Hip and lumbar bone mineral density measurements most accurate
    • Osteoporosis diagnosed with T Score ≤–2.5
    • T-score between −1.0 and −2.5 and increased risk of fracture using a formal clinical risk-assessment tool such as the US Fracture Risk Assessment (FRAX) tool
  • Clinically diagnosed if patient has a fragility fracture
    • Fracture occurs after a fall at less than standing height
    • Usual site: Hip | Humerus | Rib | Pelvis | Wrist | Spine
    • Includes asymptomatic vertebral fracture

Overview

Title

Management of Postmenopausal Osteoporosis

Authoring Organization