According to the NOF and AACE guidelines, when is pharmacologic therapy indicated for the treatment of osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The National Osteoporosis Foundation (NOF) recommends that pharmacologic therapy should be reserved for postmenopausal women and men aged 50 years or older who present with the following [4] :

  • A hip or vertebral fracture (vertebral fractures may be clinical or morphometric [ie, identified on a radiograph alone])

  • T-score of –2.5 or less at the femoral neck or spine after appropriate evaluation to exclude secondary causes

  • Low bone mass (T-score between –1.0 and –2.5 at the femoral neck or spine) and a 10-year probability of a hip fracture of 3% or greater or a 10-year probability of a major osteoporosis-related fracture of 20% or greater based on the US-adapted WHO algorithm

The 2020 updated guidelines from the American Association of Clinical Endocrinologists (AACE) are similar to NOF guidelines. The AACE strongly recommends pharmacologic treatment of osteoporosis for postmenopausal women with any of the following [11] :

  • T-score between −1.0 and −2.5 in the spine, femoral neck, total hip, or 1/3 radius 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 1/3 radius
  • T-score between −1.0 and −2.5 in the spine, femoral neck, total hip, or 1/3 radius, if the FRAX® 10-year probability for major osteoporotic fracture is ≥20% or the 10-year probability of hip fracture is ≥3% (in the U.S.) or above the country-specific threshold in other countries or regions 

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