This is the 2022 Bone Health and Osteoporosis Foundation Clinician's Guide — a comprehensive consensus statement on osteoporosis prevention, diagnosis, and treatment. It covers who to screen with DXA, how to use FRAX to set treatment thresholds, which FDA-approved agents to use and when, and how non-pharmacologic measures fit into fracture prevention. The guide targets postmenopausal women and men aged 50 and older, and directly addresses the persistent global treatment gap.
The treatment gap in osteoporosis is a recognized global crisis: 80–95% of patients are discharged after hip fracture repair without antifracture therapy, despite 1-year mortality reaching 36% and 60% of patients never regaining pre-fracture independence.
When you see any fracture in a patient over 50 — wrist, humerus, pelvis, spine, or hip. Treat it as bone fragility and initiate workup. Do not attribute it solely to trauma. An osteoporosis diagnosis established by prior fracture or T-score ≤ −2.5 persists even if subsequent DXA improves above −2.5.
In osteopenic patients (T-score −1.0 to −2.5), use FRAX to decide whether to treat: a 10-year hip fracture risk of ≥3% or major osteoporotic fracture risk of ≥20% clears the treatment threshold. For non-bisphosphonate agents (denosumab, teriparatide, abaloparatide, romosozumab), always transition to an antiresorptive on discontinuation. Stopping without a bridge causes rapid rebound bone loss.
Before elective orthopedic procedures, evaluate skeletal health and measure BMD in patients with inflammatory arthritis, osteoarthritis, chronic kidney disease, or other risk factors. Bone fragility compromises fixation and healing.
This is the 2022 Bone Health and Osteoporosis Foundation Clinician's Guide — a comprehensive consensus statement on osteoporosis prevention, diagnosis, and treatment. It covers who to screen with DXA, how to use FRAX to set treatment thresholds, which FDA-approved agents to use and when, and how non-pharmacologic measures fit into fracture prevention. The guide targets postmenopausal women and men aged 50 and older, and directly addresses the persistent global treatment gap.
The treatment gap in osteoporosis is a recognized global crisis: 80–95% of patients are discharged after hip fracture repair without antifracture therapy, despite 1-year mortality reaching 36% and 60% of patients never regaining pre-fracture independence.
When you see any fracture in a patient over 50 — wrist, humerus, pelvis, spine, or hip. Treat it as bone fragility and initiate workup. Do not attribute it solely to trauma. An osteoporosis diagnosis established by prior fracture or T-score ≤ −2.5 persists even if subsequent DXA improves above −2.5.
In osteopenic patients (T-score −1.0 to −2.5), use FRAX to decide whether to treat: a 10-year hip fracture risk of ≥3% or major osteoporotic fracture risk of ≥20% clears the treatment threshold. For non-bisphosphonate agents (denosumab, teriparatide, abaloparatide, romosozumab), always transition to an antiresorptive on discontinuation. Stopping without a bridge causes rapid rebound bone loss.
Before elective orthopedic procedures, evaluate skeletal health and measure BMD in patients with inflammatory arthritis, osteoarthritis, chronic kidney disease, or other risk factors. Bone fragility compromises fixation and healing.