Designed and created by Guideline Central in participation with the American Association of Clinical Endocrinologists
Diagnosis and Treatment of Postmenopausal Osteoporosis
Patient Guideline Summary
Publication Date: March 2, 2020
Last Updated: March 3, 2023
This patient summary means to discuss key recommendations from the American Association of Clinical Endocrinologists and for diagnosis and treatment of postmenopausal osteoporosis.
- Osteoporosis is a medical condition that softens bones, increasing their fragility.
- Osteoporosis most often occurs in postmenopausal women since estrogen is a major promotor of bone growth.
- Other causes of osteoporosis are type 1 diabetes, improper nutrition, metabolic disorders, liver disease, and medications like cortisone.
- The first symptom is usually a fracture, often from a minor impact.
- This patient summary focuses on the diagnosis and treatment of postmenopausal osteoporosis.
- All postmenopausal women aged ≥50 years should be evaluated for osteoporosis risk.
- The evaluation ordinarily includes:
- a detailed history, physical exam, and clinical fracture risk assessment with the fracture risk assessment tool (FRAX®) or other fracture risk assessment.
- an axial dual-energy X-ray absorptiometry (DXA) measurement (lumbar spine and hip or the distal third of the radius if indicated).
- bone turnover markers
- vitamin D levels.
- a search for vertebral fractures
- identifying other metabolic bone disorders and causes of secondary osteoporosis such as type 1 diabetes, glucocorticoids (cortisone), osteogenesis imperfecta, hyperthyroidism, hypogonadism, premature menopause, chronic malnutrition or malabsorption, and chronic liver disease.
- The evaluation ordinarily includes:
- Assure an adequate dietary intake of calcium to a total intake (including diet plus supplement, if needed) of 1,200 mg per day for women aged ≥50 years.
- Supplement vitamin D3, if needed, with a daily dose of 1,000 to 2,000 international units (IU).
- Stop smoking.
- Limit alcohol.
- Engage in regular weight-bearing, balance, and resistance exercises.
- Minimize the risk of falls.
- Physical therapy can greatly improve function and reduce the chance of falling.
- Oral agents include alendronate, denosumab, risedronate, and zoledronate.
- The injectable agents abaloparatide, denosumab, romosozumab, teriparatide, and zoledronate should be considered for patients unable to use oral therapy.
- Ibandronate or raloxifene may be appropriate initial therapy in some cases for patients requiring drugs with spine-specific activity.
- Sequential changes in medications are preferred to use of more than one drug at a time.
- A bisphosphonate holiday after 3–10 years of treatment may be recommended under certain conditions.
- Vertebroplasty and kyphoplasty (surgical procedures to repair vertebral fractures or collapse) are not recommended as initial treatment.
- Referral to an osteoporosis specialist, a clinical endocrinologist, or a fracture liaison team is recommended for unsatisfactory treatment results.
- The lumbar spine, total hip, or femoral neck bone studies should be repeated every 1 to 2 years until the bone mineral density is stable or increasing.
- Due to lack of standardization, using the same DXA facility is preferred.
- Bone turnover markers (BTMs) and bone formation markers may also be used to monitor treatment progress.
- Two or more fragility fractures are generally considered evidence of treatment failure.
- BTMs: Bone Turnover Markers
- DXA: Dual Energy X-ray Absorptiometry
- FRAX: Fracture Risk Assessment Tool
- IU: International Unit
Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, Harris ST, Hurley DL, Kelly J, Lewiecki EM, Pessah-Pollack R, McClung M, Wimalawansa SJ, Watts NB. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS- 2020 UPDATE EXECUTIVE SUMMARY. Endocr Pract. 2020 May;26(5):564-570. doi: 10.4158/GL-2020-0524. PMID: 32427525.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.