Osteoporosis Guidelines

Question 1

When do you initiate OP therapy?

Answer 1

T-score of -2.5 or lower
T-score between -1.0 and -2.5 and Hx of fragility fracture in hip or spine
T-score between -1.0 and -2.5 and 10-year probability of a hip fracture ≥3%
T-score between -1.0 and -2.5 and 10-year probability of major OP-related fracture ≥20%

Question 2

What medications can you give a patient at high risk but no prior fractures?

Answer 2

Alendronate, denosumab, risedronate, zolendronate

Question 3

Alternate therapy for patients at high risk but no prior fractures

Answer 3

Ibandronate, raloxifene

Question 4

How often do you monitor a patient for their response to therapy and fracture risk?

Answer 4

Yearly

Question 5

What do you do when a patient at high risk but no prior fractures has an increasing or stable BMD and no fractures while on therapy?

Answer 5

Consider a drug holiday after 3 years of IV BP therapy or 5 years of PO BP therapy

Question 6

If a patient is on a BP drug holiday, when do you resume therapy?

Answer 6

If a fracture occurs, their BMD declines beyond LSC, BTMs rise to pretreatment values or patient meets initial treatment criteria

Question 7

What medications can you give a patient at very high risk WITH prior fracture history?

Answer 7

Abaloparatide, denosumab, romozosumab, teriparatide, zoledronate

Question 8

Alternate therapy for patients at high risk with prior fracture history

Answer 8

Alendronate, risedronate

Question 9

Denosumab therapy for a patient at very high risk with prior fracture history

Answer 9

Continue therapy until the patient is no longer high risk and ensure a transition to another antiresorptive agent

Question 10

How long can romosozumab therapy last for a patient at very high risk with prior fractures?

Answer 10

12 months at most, sequential therapy with a PO or injectable antiresorptive agent

Question 11

How long can abaloparatide or teriparatide therapy last?

Answer 11

2 years, follow with sequential therapy with a PO or injectable antiresorptive agent

Question 12

How long can zolendronate therapy last for a patient at very high risk and prior fractures?

Answer 12

6 years (if the patient is stable)
If the patient isn't stable, consider switching to abaloparatide, teriparatide, or romosozumab

Question 13

What do you do when a patient who’s at high risk but with no prior fractures has bone loss progression or recurrent fractures?

Answer 13

Assess compliance and re-evaluate for causes of secondary OP

Switch to an injectable antiresorptive if on a PO agent

Switch to abaloparatide, romosozumab, or teriparatide if on injectable antiresorptive or at very high risk of fracture