Osteoporosis Practice Bulletin

Publication Date: September 1, 2012

Recommendations and Conclusions

The following recommendations and are based on good and consistent scientific evidence.

  • Treatment should be recommended for:
    • Women with a T-score of –2.5 or less
    • Women who have had low-trauma fracture
    • Women who have a T-score from –1 to –2.5 and a FRAX score greater than or equal to 3% for risk of hip fracture or a FRAX score greater than or equal to 20% for risk of a major osteoporotic fracture (defined as forearm, hip, shoulder, or clinical spine fracture) or both in the next 10 years
  • FDA-approved therapies should be used for medical treatment: raloxifene, bisphosphonates, PTH, denosumab, calcitonin.
  • Bone density screening for women should begin at age 65 years. Dual-energy X-ray absorptiometry screening can be used selectively for women younger than 65 years if they are postmenopausal and have other significant risk factors for osteoporosis or fracture.

The following recommendations and conclusions are based on limited or inconsistent scientific evidence.

  • In the absence of new risk factors, DXA screening should not be performed more frequently than every 2 years.
  • In the absence of new risk factors, DXA monitoring of therapy should not be repeated once BMD has been determined to be stable or improved.
  • Women should be counseled about lifestyle factors that may affect BMD and fracture risk: smoking, poor nutrition and excessive weight loss, weight- bearing and muscle-strengthening exercise, and fall- prevention measures.
  • Women should be advised of current IOM calcium and vitamin D recommendations.

The following conclusion is based primarily on consensus and expert opinion.

The effect of lifestyle on bone health should be considered for girls and women of all ages and they should be counseled accordingly.

Recommendation Grading




Osteoporosis Practice Bulletin

Authoring Organization

Publication Month/Year

September 1, 2012

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adult, Older adult

Health Care Settings


Intended Users

Nurse, nurse midwife, physician, nurse practitioner, physician assistant


Diagnosis, Treatment, Management

Diseases/Conditions (MeSH)

D010024 - Osteoporosis