Diagnosis and Treatment of Postmenopausal Osteoporosis

Evaluate all postmenopausal women aged ≥50 years for osteoporosis risk. (I, B)

A detailed history, physical exam, and clinical fracture risk assessment with fracture risk assessment tool (FRAX®) or other fracture risk assessment tool should be included in the initial evaluation for osteoporosis. (I, B)

Consider bone mineral density testing based on clinical fracture risk profile. (II, B)

When bone mineral density is measured, axial dual-energy X-ray absorptiometry (DXA) measurement (lumbar spine and hip; 1/3 radius if indicated) should be used. (II, B)

Osteoporosis is diagnosed based on presence of fragility fractures in the absence of other metabolic bone disorders and even with a normal bone mineral density (T-score). (II, B)

Osteoporosis is also diagnosed based on a T-score of −2.5 or lower in the lumbar spine (antero-posterior), femoral neck, total hip, or 1/3 radius (33% radius), even in the absence of a prevalent fracture. (IV, B)

When the initial diagnosis of osteoporosis is made according to a T-score of −2.5 or below, the diagnosis persists even when a subsequent dual-energy X-ray absorptiometry (DXA) measurement shows a T-score better than −2.5. (IV, B)

Osteoporosis may also be diagnosed in patients with a T-score between −1.0 and −2.5 and increased fracture risk using FRAX® (fracture risk assessment tool) country-specific thresholds.

(II, B)