What are the criteria for the diagnosis 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

According to National Osteoporosis Foundation guidelines, a clinical diagnosis of osteoporosis may be made in a postmenopausal woman or in a man over age 50 years who is at an elevated risk for fracture, as indicated by any of the following [246] :

  • T-score of -2.5 or less at the spine or hip as determined by dual-energy x-ray absorptiometry (DXA)
  • Hip fracture, with or without bone mineral density (BMD) testing
  • Vertebral; proximal humerus; pelvis; or, in some cases, distal forearm fracture in the setting of low bone mass (osteopenia) confirmed by DXA
  • FRAX score with 10-year risk for hip fracture ≥3% or for major osteoporotic fracture ≥20% in a patient with osteopenia

The 2020 update of the American Association of Clinical Endocrinologists (AACE) guidelines provides the following criteria for the diagnosis of osteoporosis in postmenopausal women [11] :

  • 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 BMD)
  • 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® fracture probability based on country-specific thresholds

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