🦴 Osteoporosis: Starting Anti-Osteoporosis Therapy
This tool decides whether to start anti-osteoporosis therapy and at what intensity, integrating fragility-fracture history, BMD T-score, and FRAX 10-year fracture probability.
Osteoporosis: Starting Anti-Osteoporosis Therapy
Hip or vertebral fragility-fracture history
Fragility fracture at other sites
BMD T-score (lowest site)
FRAX 10-year major osteoporotic fracture probability (optional) (%)
FRAX 10-year hip fracture probability (optional) (%)
When to use
Use to triage treatment: a hip/vertebral fragility fracture or T-score ≤ -2.5 mandates therapy, while low bone mass is treated when accompanied by another fragility fracture or high FRAX risk.
How it works
Treat if hip/vertebral fragility fracture, T ≤ -2.5, or low bone mass (-2.5 < T ≤ -1.0) with another fragility fracture or FRAX major ≥ 20%/hip ≥ 3%. Very high risk (FRAX major > 30%/hip > 4.5%, T ≤ -3.0) selects more potent agents.
Key points
- A hip or vertebral fragility fracture diagnoses osteoporosis and triggers treatment independent of the BMD value. (original synthesis · not guideline verbatim)
- Very-high-risk patients are candidates for anabolic or more potent agents (teriparatide, romosozumab, denosumab, zoledronic acid).
- All patients receive calcium, vitamin D, weight-bearing exercise, fall prevention, and a secondary-cause workup.
References
- Chinese Society of Osteoporosis and Bone Mineral Research. Guideline for the diagnosis and treatment of primary osteoporosis (2022).
- Camacho PM, et al. AACE/ACE Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis — 2020 Update.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.