Synopsis
Estimate fragility-fracture risk, identify secondary causes and start timely bone protection with explicit duration, adherence and discontinuation planning.
- Osteoporosis is a disorder of reduced bone strength and fragility fracture risk; many fractures occur above a DXA T-score of minus 2.5, so density is not the whole diagnosis.
- Use FRAX without BMD initially for appropriate adults, then obtain DXA when the result will refine an intermediate decision or provide a useful baseline.
- A prior or recent fragility fracture, multiple vertebral fractures, very low BMD or high-dose glucocorticoids can define high or very high risk requiring prompt treatment.
Investigation priorities
Estimate ten-year major osteoporotic and hip fracture probabilities from validated clinical risk factors, initially without BMD when appropriate.
Management branches
Age, risk factor, glucocorticoid exposure or low-trauma fracture raises concern for osteoporosis.
- Record fracture timing and mechanism, parental history, smoking, alcohol, glucocorticoid dose, comorbidity, falls and secondary-cause clues.
- Calculate FRAX and apply current NOGG thresholds, obtaining DXA and vertebral imaging when they will refine the risk category or treatment choice.
Key medicines
Alendronic acidUse the licensed once-weekly osteoporosis regimen, taken after an overnight fast with plain water while upright, delaying food and other medicines for the product-specified interval.
Intravenous zoledronic acidGive the licensed osteoporosis infusion at the NOGG and local protocol interval after checking calcium, vitamin D, hydration and creatinine clearance; administer through a trained service.