From the Guidelines
The primary indications for osteoporosis treatment are a bone mineral density T-score of -2.5 or lower at the hip or spine, a history of hip or vertebral fracture, and a T-score between -1.0 and -2.5 with a high FRAX score (10-year probability of major osteoporotic fracture ≥20% or hip fracture ≥3%). According to the most recent study 1, the World Health Organization (WHO) defines osteoporosis as a T-score of -2.5 or lower, which is a key indicator for treatment. The study also highlights the importance of using FRAX, a fracture risk assessment tool, to predict fracture risk in patients with low bone mass. Key risk factors for osteoporotic fracture include increasing age, female sex, post-menopause, low body weight, and history of parental hip fracture, as noted in the study 1. Some of the other indications for osteoporosis treatment include:
- A history of hip or vertebral fracture
- A T-score between -1.0 and -2.5 with a high FRAX score
- Low bone mass or osteopenia with other risk factors such as rheumatoid arthritis, current smoking, or alcohol intake The study 1 also emphasizes the importance of regular bone density screening, particularly for women 65 and older, and for younger postmenopausal women with risk factors. In terms of treatment, first-line options typically involve oral bisphosphonates such as alendronate or risedronate, as well as calcium and vitamin D supplementation, weight-bearing and resistance exercises, and fall prevention strategies. For patients who cannot tolerate oral bisphosphonates, alternatives include intravenous zoledronic acid, subcutaneous denosumab, and oral raloxifene for postmenopausal women. Treatment duration varies, but typically involves 3-5 years of bisphosphonate therapy followed by a reassessment of fracture risk. Overall, early diagnosis and treatment are crucial in preventing fractures and improving quality of life for patients with osteoporosis, as highlighted in the study 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE 1.1 Postmenopausal Osteoporosis 1.2 Important Limitations of Use 2.1 Treatment of Postmenopausal Osteoporosis 14. 1 Treatment of Osteoporosis in Postmenopausal Women
The indications of Osteoporosis for risedronate (PO) are:
- Postmenopausal Osteoporosis 2
From the Research
Indications of Osteoporosis
The indications of osteoporosis can be identified through various methods, including:
- Bone mineral density (BMD) T-score of -2.5 or lower, as confirmed by DEXA scan 3
- Presence of fragility fractures, such as vertebral fractures, which are generally considered diagnostic of osteoporosis, even if spine BMD values are not in the osteoporotic range 3, 4, 5
- Elevated 10-year fracture probability, as calculated by fracture risk assessment tools such as FRAX 3, 4, 5
- Clinical risk factors, such as increasing age, female gender, long-term corticosteroid therapy, chronic inflammatory disease, malabsorption, and untreated premature menopause 3
Diagnostic Criteria
The diagnosis of osteoporosis can be confirmed by:
- DEXA scan, which measures BMD at the lumbar spine, femoral neck, or total hip 3
- Presence of a fragility fracture, which can be diagnostic of osteoporosis even if BMD values are not in the osteoporotic range 3, 4, 5
- Fracture probability-based scores, which can help identify individuals at high risk of fracture 4
Treatment Thresholds
Treatment for osteoporosis is generally recommended for individuals with: