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Last Updated: 8/4/2014  

Osteoporosis

Prevention
  • Ensure that individuals of all ages receive an adequate intake of calcium and vitamin D.

  • Ensure regular physical activity at all ages to optimize peak bone mass and minimize subsequent bone loss, and counsel patients to avoid cigarette smoking and excess alcohol consumption.

Screening
  • Screen women age 65 or older and men age 75 or older with DXA (dual-energy x-ray absorptiometry). Initiate screening in younger patients if they are at increased risk for osteoporosis or fracture.

Diagnosis
  • Ask patients about diet, lifestyle, medications, family history, falls, and previous fractures, and perform a focused physical exam looking for evidence of secondary causes of osteoporosis.

  • Perform DXA in patients with suspected osteoporosis.

  • Evaluate patients with osteoporosis for the most common underlying conditions by checking calcium, phosphate, and creatinine levels as well as CBC, thyroid, and liver studies in most patients. Consider additional testing when clinically indicated.

Therapy
  • Ensure oral calcium intake of 1200 mg/d and vitamin D intake of 800 IU/d in postmenopausal women.

  • Use bisphosphonates as first-line treatment, starting with alendronate or risedronate.

  • Consider second-line agents in patients who cannot tolerate or do not respond to bisphosphonates, including denosumab, raloxifene, and teriparatide.

  • Repeat DXA 1 to 2 years after initiation of therapy to assess response.

DOI: 10.7326/d297
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
E. Michael Lewiecki, MD, FACP has received grant/research support (principal investigator, funding to New Mexico Clinical Research & Osteoporosis Center) from Amgen, Eli Lilly, Novartis, Merck, Warner Chilcott and Genentech. He serves on the Board of Directors of the International Society for Clinical Densitometry; on the Scientific Advisory Boards of Amgen, Eli Lilly, Novartis, Genentech and Merck; and on the Speakers' Bureaus of Amgen, Eli Lilly, Novartis and Genentech. Silvio Inzucchi, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Francis Luk, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Carolyn Riester O’Connor, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Deborah Korenstein, MD, FACP, Editor in Chief, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Richard B. Lynn, MD, FACP, Editor, ACP Smart Medicine, has no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
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