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- Figure 1
An algorithm for initial fracture risk assessment and reassessment in adult patients, based on current guidelines.
Adapted from information in reference 9.
Tables
Dose Age 40 50 60 70 80 90 All For hip fracture risk Lowa Multiply FRAX score by: 0.60 0.60 0.50 0.40 0.70 0.70 0.65 Highb Multiply FRAX score by: 1.25 1.25 1.25 1.20 1.10 1.10 1.20 For major osteoporotic fracture risk Lowa Multiply FRAX score by: 0.80 0.80 0.85 0.80 0.80 0.80 0.80 Highb Multiply FRAX score by: 1.20 1.20 1.15 1.15 1.10 1.10 1.15 Fracture risk Treatment Low Calcium and vitamin D Moderate or high Calcium and vitamin D and An oral bisphosphonate or one of the following
(in order of preference)An intravenous bisphosphonate Teriparatide Denosumab Raloxifene (postmenopausal women) Based on information in reference 9.
Oral bisphosphonates Preferred because of safety, low cost, and lack of evidence of superior antifracture benefits from other osteoporosis medications Avoid in patients with gastroesophageal reflux disease or esophagitis Intravenous bisphosphonates Higher risk with intravenous infusion (than with oral bisphosphonate therapy) of hypersensitivity reaction, acute-phase reaction (influenza-like illness), hypocalcemia Longer half-life Consider for better adherence, given no weekly pill burden Teriparatide Expensive; burden of therapy with daily injections Limited to 2 years of therapy Caution in patients with urolithiasis Denosumab Lack of safety data in premenopausal women Hypersensitivity reaction, infection risk Based on information in reference 9.
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