| AACE, 2016327 | Postmenopausal
women | Screening
Evaluate all postmenopausal women age 50 years or older for osteoporosis risk Include a detailed history, physical exam, and clinical fracture risk assessment with FRAX in the initial evaluation for osteoporosis Consider BMD testing based on clinical fracture risk profile When BMD is measured, use DXA measurement (spine and hip) Osteoporosis should be diagnosed based on presence of fragility fractures in the absence of other metabolic bone disorders or a T-score of -2.5 or lower in the lumbar spine, femoral neck, total hip, and/or 33% (one-third) radius even in the absence of a prevalent fracture Osteoporosis may also be diagnosed in patients with osteopenia and increased fracture risk using FRAX country-specific threshold
Evaluation
Treatment for patients withOsteopenia or low bone mass and a history of fragility fracture of the hip or spine T-score of -2.5 or lower in the spine, femoral neck, total hip, or 33% radius T-score between -1.0 and -2.5 if the FRAX 10-year probability for major osteoporotic fracture is ≥20% or the 10-year probability of hip fracture is ≥3% in the United States or above the country-specific threshold in other countries or regions
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| AAFP, 2011328 | Postmenopausal women Men | Same recommendations as the 2011 USPSTF recommendations (recommended screening for osteoporosis in women age 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year old white woman who has no additional risk factors, insufficient evidence to assess the balance of benefits and harms of screening for osteoporosis in men) |
| ACOG, 2012 (reaffirmed in 2014)329 | Women | Recommend BMD testing by DXA:
for all women age 65 years or older for younger women if they are postmenopausal and have other risk factors for fracture and/or a 10-year FRAX risk of fracture of ≥9.3% at intervals not more frequent than every 2 years
Recommend FDA-approved therapies for women with BMD diagnostic of osteoporosis or women with osteopenia and 10-year FRAX probability of major osteoporosis risk ≥20% or hip fracture risk ≥3%
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| ACPM, 2009330 | Women age 65 years or older Men age 70 years or older | Recommend BMD testing with DXA for all women age 65 years or older years and men age 70 years or older, and not more frequently than every 2 years Younger postmenopausal women and men ages 50-69 years should undergo screening if they have at least one major or two minor risk factors for osteoporosis Osteoporosis risk assessment tools that estimate absolute fracture risk can be useful supplements to BMD testing, improving the sensitivity and specificity of either approach (BMD or risk assessment) alone; risk assessment can also be used if BMD testing is not readily available or feasible
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| ACR, 2016331 | Asymptomatic BMD screening or individuals with established or clinically suspected low BMD, patients with T-scores less than -1.0 with additional risk factors, premenopausal females with risk factors, and males 20-50 years of age with risk factors | Rate appropriateness and relative radiation levels of various tests for identifying low bone density and fracture risk |
| Endocrine Society, 2012332 | Higher-risk men | Recommend BMD testing by central DXA in1. men age 70 years or older men ages 50-69 years with risk factors (e.g., low body weight, prior fracture as an adult, smoking)
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| ISCD, 201565 | Men and postmenopausal women | Indications for BMD testing:women age 65 or older postmenopausal women under 65 years of age with risk factors for low bone mass women during the menopausal transition with clinical risk factors for fracture, such as low body weight, prior fracture, or high-risk medication use men age 70 years or older men under 70 years of age with clinical risk factors for low bone mass adults with a fragility fracture adults with a disease or condition associated with low bone mass or bone loss adults taking medications associated with low bone mass or bone loss anyone being considered for pharmacologic therapy for osteoporosis anyone being treated for osteoporosis to monitor treatment effect lanyone not receiving therapy in whom evidence of bone loss would lead to treatment women discontinuing estrogen should be considered for bone density testing according to the indications listed above
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| NOF, 20145 | Men age 50 or older and postmenopausal women | Recommend BMD testing with DXA for women age 65 years or older and men age 70 years or older postmenopausal women and men ages 50-69 years based on risk factor profile postmenopausal women and men age 50 years or older who have had an adult-age fracture
Recommend pharmacologic treatment in those with T-scores <-2.5, in postmenopausal women and mean age 50 years or older with T-scores between -1.0 and -2.5 and a 10-year FRAX probability of major osteoporosis-related fracture ≥20% or hip fracture probability ≥3%
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| NICE, 2012333 | Persons presenting in any health care setting |
Consider assessment of fracture risk:
Do not routinely assess fracture risk in people under 50 years of age unless they have major risk factors (for example, current or frequent recent use of oral or systemic glucocorticoids, untreated premature menopause, or previous fragility fracture), because they are unlikely to be at high risk Consider measuring BMD with DXA in people whose absolute fracture risk (via FRAX or QFracture) is in the region of an intervention threshold for a proposed treatment, and recalculate FRAX with BMD value
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| North American Menopause Society, 2010334 | Postmenopausal women | Measure height and weight annually and assess chronic back pain, kyphosis, and clinical risk factors Recommend BMD testing with DXA in postmenopausal women with medical causes of bone loss and all women age 65 years or older Recommend BMD testing with DXA for postmenopausal women age 50 years or older with risk factors of previous fracture, thinness, history of hip fracture in parent, current smoking, rheumatoid arthritis, or excessive alcohol intake Vertebral fracture must be confirmed by lateral spine radiographs or vertebral fracture assessment visualization of fracture at the time of BMD testing Recommendations of calcium intake of 1,200 mg/day for adults age 50 years or older, and vitamin D3 of 800 to 1,000 IU/day Recommend pharmacologic treatment in postmenopausal women who have had an osteoporotic vertebral or hip fracture, postmenopausal women who have BMD values consistent with osteoporosis (i.e., T-scores ≤-2.5) at the lumbar spine, femoral neck, or total hip region, and postmenopausal women who have a T-score from -1.0 to -2.5 and a 10-year risk, based on the FRAX calculator, of at least 20% for major osteoporotic fracture (spine, hip, shoulder, and wrist) or at least 3% for hip fracture Recommend repeating BMD testing 1-2 years after treatment For untreated postmenopausal women, repeat DXA testing is not useful until 2-5 years have passed Recommend bisphosphonates as the first-line drugs for treating postmenopausal women with osteoporosis Recommend SERM raloxifene for postmenopausal women with low bone mass or younger postmenopausal women with osteoporosis Recommend teriparatide (PTH 1-34) for postmenopausal women with osteoporosis who are at high risk of fracture with therapy indicated for no more than 24 months
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| Scientific Advisory Council of Osteoporosis Canada, 2010335 | Men and women older than 50 years of age | Measure height annually and assess for vertebral fracture Assess history of falls Perform biochemical testing in select patients to rule out secondary causes of osteoporosis Perform lateral thoracic and lumbar spine radiography or DXA if clinical evidence suggests fracture Use the 2010 version of the Canadian Association of Radiologists and Osteoporosis Canada tool or Canadian version of FRAX to assess absolute risk of fracture; offer treatment to individuals with a 10-year risk of >20% for major osteoporotic fractures
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| UKNSC, 2013336 | Postmenopausal women | Systematic population screening not recommended because no RCT has assessed the clinical and cost effectiveness of any current approach to screening for osteoporosis |
| WHO, 2008337 | Men and women 40-90 years of age | DXA and an assessment tool for case-finding high-risk individuals (FRAX) should be used to evaluate fracture risks for men and women.
Recommend treatment with FDA-approved medication to lower risk in three high-risk groups:
history of fracture of the hip or spine BMD in the osteoporosis range (T-score of -2.5 or lower) BMD in the low bone mass or osteopenia range with a higher risk of fracture defined by FRAX score for
- a.
major osteoporotic fracture 10-year probability of 20% or higher OR - b.
hip fracture 10-year probability 3% or higher
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