ACOG Management of Postmenopausal Osteoporosis Guideline Summary

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

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

Management of Postmenopausal Osteoporosis