Management of Postmenopausal Osteoporosis
Publication Date: March 31, 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
Title
Management of Postmenopausal Osteoporosis
Authoring Organization
American College of Obstetricians and Gynecologists