Written by Barbara Hoefener FNP 4/2021
Quick Reference Guide for Patients: Osteoporosis
When do I test my bones for strength or osteoporosis?
-Women 65y + or menopausal with risk factors
-Man 70y+ or 50+ with risk factors
-You break a bone at 50+yr
You have completed your DEXA scan, now what?
Your major joints (Lumbar spine, total left and right hip, right and left femoral neck, and forearm) have been "scored" into a "T number"
-Normal is -1 to 0
-Osteopenia is -1 to -2.5 (lifestyle intervention and supplements)
-Osteoporosis is -2.5 to -3.5 (start treatment)
-Severe osteoporosis is below -3.5
You will get a read out showing your 10 year fracture risk of 1. Any bone and 2. your hip bone
Treatment varies but the general rule of thumb is as follows (per UpToDate)
Guidelines for Osteoporosis Treatment in postmenopausal women and men ≥50 years of age (per UpToDate):
1. History of hip or vertebral fracture.
2. T-score ≤-2.5 (DXA) at the femoral neck or spine, after appropriate evaluation to exclude secondary causes.
3. T-score between -1 and -2.5 at the femoral neck or spine, and a 10-year probability of hip fracture ≥3 percent or a 10-year probability of any major osteoporosis-related fracture ≥20 percent based upon the United States-adapted WHO algorithm.
Treatment:
1. Lifestyle measures include adequate calcium and vitamin D, exercise, smoking cessation, counseling on fall prevention, and avoidance of heavy alcohol use. In general, 1200 mg of elemental calcium daily, total diet plus supplement, and 800 international units of vitamin D daily are advised.
2 We suggest to start treatment with alendronate or risedronate as our choice of bisphosphonate due to efficacy in reducing vertebral and hip fracture.
3. For patients with severe osteoporosis (eg, T-score of ≤-3.5 even in the absence of fractures, T-score of ≤-2.5 plus a fragility fracture, severe or multiple vertebral fractures), some UpToDate experts prefer initial treatment with an anabolic agent (teriparatide, abaloparatide, romosozumab)
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