This NOF position paper provides evidence-based recommendations for preventing, diagnosing, and treating osteoporosis in postmenopausal women and men age 50 and older. It covers BMD testing indications, FRAX-based treatment thresholds derived from US cost-effectiveness modeling, and fracture risk reductions for all FDA-approved pharmacologic agents. It is the foundational clinical reference for osteoporosis management in orthopedic practice.
Only 23% of women over 67 who sustain an osteoporotic fracture receive a BMD test or pharmacologic therapy within 6 months — this paper exists to close that gap. When you see a patient over 50 with any fragility fracture (hip, vertebral, wrist, humerus), that fracture is itself an indication to initiate pharmacologic therapy and coordinate osteoporosis workup, regardless of T-score.
For patients with osteopenia, run FRAX: treat if 10-year hip risk is ≥3% or major fracture risk is ≥20%. For patients already on bisphosphonates, reassess at 3–5 years. Low-risk patients can take a drug holiday, high-risk patients should continue or transition.
Atypical femur fractures are associated with bisphosphonate use beyond 5 years and present with prodromal thigh or groin pain. When suspected, order bilateral femur X-rays and follow with MRI or bone scan if clinical suspicion remains high.
This NOF position paper provides evidence-based recommendations for preventing, diagnosing, and treating osteoporosis in postmenopausal women and men age 50 and older. It covers BMD testing indications, FRAX-based treatment thresholds derived from US cost-effectiveness modeling, and fracture risk reductions for all FDA-approved pharmacologic agents. It is the foundational clinical reference for osteoporosis management in orthopedic practice.
Only 23% of women over 67 who sustain an osteoporotic fracture receive a BMD test or pharmacologic therapy within 6 months — this paper exists to close that gap. When you see a patient over 50 with any fragility fracture (hip, vertebral, wrist, humerus), that fracture is itself an indication to initiate pharmacologic therapy and coordinate osteoporosis workup, regardless of T-score.
For patients with osteopenia, run FRAX: treat if 10-year hip risk is ≥3% or major fracture risk is ≥20%. For patients already on bisphosphonates, reassess at 3–5 years. Low-risk patients can take a drug holiday, high-risk patients should continue or transition.
Atypical femur fractures are associated with bisphosphonate use beyond 5 years and present with prodromal thigh or groin pain. When suspected, order bilateral femur X-rays and follow with MRI or bone scan if clinical suspicion remains high.