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Diagnosis and management

88% of women > 50 years of age do not receive treatment within 12
months post fracture.1

Assessing osteoporosis

The initial evaluation for osteoporosis should include:2

  • Detailed medical history
  • Physical examination, which may show kyphosis, height loss, or possible predictors of fracture
  • Clinical risk factor assessment

Risk Factors for Future Fracture2

Prior fracture

Age > 65 years

Low BMD (T-score ≤ -2.5)

Other risk factors

Risk Factors
  • Parental history of hip fracture
  • Low body weight, small frame
  • Immobilization
  • Excessive alcohol intake (≥ 3 drinks/day)
  • Cigarette smoking
  • Long-term glucocorticoid use
  • Risk of falling
  • Rheumatoid arthritis
  • Diabetes

Do you know who among your patients should be evaluated for postmenopausal osteoporosis? It’s time to improve diagnosis and implement effective management strategies—and it starts by identifying who among your patients may be at risk.

Making the diagnosis

2020 AACE Guidelines for the Diagnosis of Postmenopausal Osteoporosis2

  • T-score –2.5 or below in the lumbar spine, femoral neck, total proximal femur, or 1/3 radius
  • Low-trauma spine or hip fracture (regardless of bone mineral density)
  • T-score between –1.0 and –2.5 and a fragility fracture of proximal humerus, pelvis, or distal forearm
  • T-score between –1.0 and –2.5 and high FRAX® (or if available, TBS-adjusted FRAX®) fracture probability based on country-specific threshold

Did you know?

Once the diagnosis of osteoporosis has been made, the diagnosis persists even if treatment results in a T-score better than –2.5.2

Determining VHFR

According to the 2020 AACE Guidelines, criteria for very high risk of fracture may include:2

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Had a recent fracture

(eg, within the past 12 months)

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Had a fracture while on approved therapy for osteoporosis
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Had fractures while 
on drugs causing 
skeletal harm
ICON of MultipleFracture
Exprienced multiple fractures
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Very low T-score

(eg, less than –3.0)

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High risk for falls or history of injurious falls
Icon of hip fracture

Very high fracture probability per FRAX®

(eg, > 30% major osteoporotic fracture, > 4.5% hip fracture)

Did you know?

35% of subsequent fractures occur within the first year following the initial fracture.3

Evaluating patients for osteoporosis and their fracture risk requires consideration of several factors

Video thumbnail for "Treatment and evaluation guideline recommendations"
Treatment and evaluation guideline recommendations
Learn about tools and clinical risk factors to identify patients at high risk.

Management Strategies

Understanding the latest guidelines and position statements can help determine the best management strategy for your patients.

  • The 2020 AACE Osteoporosis Guidelines stratify patients as being either at high risk for fracture or very high risk for fracture to help determine initial treatment choice2

See the Full AACE Guidelines

  • The ASBMR/BHOF Task Force position statement on goal-directed osteoporosis management recommend the use of anabolics for patients at very high risk for fracture4,†

Read the position statement

Pharmacologic therapy is often needed to effectively reduce the risk of osteoporosis-related fracture  

While calcium-rich diets and weight-bearing exercises are important components of managing postmenopausal osteoporosis, they alone may not adequately reduce the risk of fractures.2,4,5 For these patients, the goal of treatment is to reduce the risk of fracture by either building new bone or slowing bone loss.2,7

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Anabolic agents build bone by increasing the activity level of osteoblasts7

Icon of a "slow" signIcon of a "slow" sign

Antiresorptive agents slow bone loss by helping to stop osteoclast activity, leading to less bone loss7

Learn more about an anabolic option

*Data are from a patient claims dataset from IQVIA for women over age 50 diagnosed with or treated for osteoporosis, had a fragility fracture, or with at least one medical or pharmacy claim between January 2019–December 2023. Fractures were counted if there was a diagnosis or procedure code for a fragility fracture of the hip, vertebra, femur, pelvis, humerus, radius/ulna, tibia/fibula, or clavicle. For patients with at least one fragility fracture between January 2019– December 2022, claims records were examined for post-fracture care, including the number of patients with a diagnosis code, DXA scan code, or a prescription for an osteoporosis treatment.1

†The 2024 ASBMR/BHOF Task Force position statement represents the consensus of the ASBMR/BHOF Task Force on goal-directed osteoporosis treatment, based on interpretation of the best evidence available. The position statement is not a clinical guideline.4

AACE, American Association of Clinical Endocrinology; ASBMR/BHOF, American Society for Bone and Mineral Research/Bone Health and Osteoporosis Foundation; DXA, dual-energy x-ray absorptiometry; FRAX, Fracture Risk Assessment Tool; TBS, trabecular bone scan; VHFR, very high fracture risk.

References: 1. Data on file, Amgen; 2024. 2. Camacho PM, Petak S, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract. 2020;26(suppl 1):1‐46. 3. Balasubramanian A, Zhang J, Chen L, et al. Risk of subsequent fracture after prior fracture among older women. Osteoporos Int. 2019;30:79-92 4. Cosman F, Lewiecki EM, Eastell R, et al. Goal-directed osteoporosis treatment: ASBMR/BHOF task force position statement 2024. J Bone Miner Res. 2024;39:1393-1405. 5. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25:2359-2381. 6. LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician’s guide to prevention and treatment of osteoporosis.Osteoporos Int. 2022;33:2049-2102. 7. Haas AV, LeBoff MS. Osteoanabolic agents for osteoporosis. J Endocr Soc. 2018;2:922-932.