Endocrinology Search
Endocrinology Endocrinology
osteoporosis
OSTEOPOROSIS
Treatment Guideline Chart
Osteoporosis is a progressive, systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration of bone tissue leading to increased bone fragility and susceptibility to fractures.
The more risk factors (eg history of fracture, advanced age, comorbidities, etc) that are present, the greater the risk of fracture.

Osteoporosis References

  1. American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced Osteoporosis. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. Arthritis Rheum. 2001 Jul;44(7):1496-1503. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 11465699
  2. Bonura F. Prevention, screening and management of osteoporosis: an overview of the current strategies. Postgrad Med. 2009 Jul;121(4):5-17. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 19641263
  3. Brown JP, Fortier M, et al; Osteoporosis Guidelines Committee. Canadian Consensus Conference on osteoporosis, 2006 update. J Obstet Gynaecol Can. 2006 Feb;28(2)(Suppl 1):S95-S112. http://www.ncbi.nlm.nih.gov/pubmed/. PMID: 16626523
  4. Campion JM, Maricic MJ. Osteoporosis in men. Am Fam Physician. 2003 Apr;67(7):1521-1526. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 12722852
  5. Compston J. Clinical and therapeutic aspects of osteoporosis. Eur J Radiol. 2009 Sep;71(3):388-391. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 19660883
  6. Compston J, Cooper A, Cooper C, et al; National Osteoporosis Guideline Group (NOGG). Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas. 2009 Feb;62(2):105-108. doi: 10.1016/j.maturitas.2008.11.022. PMID: 19135323
  7. Dell RM, Greene D, Anderson D, et al. Osteoporosis disease management: what every orthopaedic surgeon should know. J Bone Joint Surg Am. 2009 Nov;91(Suppl 6):79-86. doi: 10.2106/JBJS.I.00521. PMID: 19884415
  8. Delmas PD. Treatment of postmenopausal osteoporosis. Lancet. 2002 Jun;359(9322):2018-2026. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 12076571
  9. Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res (Hoboken). 2010 Nov;62(11):1515-1526. http://www.rheumatology.org/. Accessed 13 Sep 2013. PMID: 20662044
  10. Delmas PD, Eastell R, Garnero P, et al; Committee of Scientific Advisors of the International Osteoporosis Foundation. The use of biochemical markers of bone turnover in osteoporosis. Osteoporos Int. 2000;11(Suppl 6):S2-S17. doi: 10.1007/s001980070002. PMID: 11193237
  11. Hodgson SF, Watts NB, Bilezikian JP, et al; AACE Osteoporosis Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. 2003 Nov;9(6):544-564. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 14715483
  12. Kanis JA, Burlet N, Cooper C, et al; European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2008 Apr;19(4):399-428. http://www.ncbi.nlm.nih.gov/pubmed/. PMID: 18266020
  13. Kanis JA, McCloskey EV, Johansson H, et al. Approaches to the targeting of treatment for osteoporosis. Nat Rev Rheumatol. 2009 Aug;5(8):425-431. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 19648943
  14. Lau EM, Sambrook P, Seeman E, et al. Guidelines for diagnosing, prevention and treatment of osteoporosis in Asia. APLAR J Rheumatol. 2006 Apr;9(1):24-36. https://doi.org/10.1111/j.1479-8077.2006.00161.x.
  15. Levine JP. Pharmacologic and nonpharmacologic management of osteoporosis. Clin Cornerstone. 2006;8(1):40-53. http://www.ncbi.nlm.nih.gov/. PMID: 17591575
  16. Leweicki EM. Managing osteoporosis: challenges and strategies. Cleve Clin J Med. 2009 Aug;76(8):457-466. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 19652039
  17. Leweicki EM. Prevention and treatment of postmenopausal osteoporosis. Obstet Gynecol Clin North Am. 2008 Jun;35(2):301-315. doi: 10.1016/j.ogc.2008.03.007. PMID: 18486843
  18. Leweicki EM. Current and emerging pharmacologic therapies for the management of postmenopausal osteoporosis. J Womens Health (Larchmt). 2009 Oct;18(10):1615-1626. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 19857095
  19. Mayes SL. Review of postmenopausal osteoporosis pharmacotherapy. Nutr Clin Pract. 2007 Jun;22(3):276-285. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 17507728
  20. Mazziotti G, Giustina A, Canalis E, et al. Glucocorticoid-induced osteoporosis: clinical and therapeutic aspects. Arq Bras Endocrinol Metabol. 2007 Nov;51(8):1404-1412. doi: 10.1590/S0004-27302007000800028. PMID: 18209880
  21. Miller PD. Safety of parathyroid hormone for the treatment of osteoporosis. Curr Osteoporos Rep. 2008 Mar;6(1):012-016. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 18430395
  22. Muenier P, Roux C, Seeman E, et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med. 2004 Jan;350(5):459-468. http://www.nejm.org. PMID: 14749454
  23. National Institute of Health. Osteoporosis prevention, diagnosis and therapy. NIH Consensus Statement. 2000 Mar;17(1):001-36. http://consensus.nih.gov/.
  24. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001 May;344(19):1434-1441. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 11346808
  25. North American Menopause Society (NAMS). Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010 Mar;17(2):242-255. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 20154637
  26. Poole KES, Compston JE. Osteoporosis and its management. BMJ. 2006 Dec;333(7581):1251-1256. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 17170416
  27. Reginster J, Lecart M, Deroisy R, et al. Strontium ranelate: a new paradigm in the treatment of osteoporosis. Expert Opin Investig Drugs. 2004 Jul;13(7):857-864. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 15212623
  28. Rahmani P, Morin S. Prevention of osteoporosis-related fractures among postmenopausal women and older men. CMAJ. 2009 Nov;181(11):815-820. doi: 10.1503/cmaj.080709. PMID: 19841053
  29. Saag KG, Shane E, Boonen S, et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med. 2007 Nov;357(20):2028-2039. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 18003959
  30. Sambrook PN, Seeman E, Phillips SR, et al; Osteoporosis Australia; National Prescribing Service. Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit. Med J Aust. 2002 Apr 15;176(S8):S1-S16. http://www.ncbi.nlm.nih.gov/pubmed/?term=12049064. PMID: 12049064
  31. Seeman E, Eisman J. Treatment of osteoporosis: why, whom, when and how to treat. The single most important consideration is the individual's absolute risk of fracture. Med J Aust. 2004 Mar;180(6):298-303. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 15012571
  32. South-Paul JE. Osteoporosis: part II. Nonpharmacologic and pharmacologic treatment. Am Fam Physician. 2001 Mar;63(6):1121-1128. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 11277549
  33. South-Paul JE. Osteoporosis: part I. Evaluation and assessment. Am Fam Physician. 2001 Mar;63(5):897-904, 908. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 11261866
  34. Stránský M, Rysavá L. Nutrition as prevention and treatment of osteoporosis. Physiol Res. 2009;58(Suppl 1):S7-S11. http://www.ncbi.nlm.nih.gov/. PMID: 19857038
  35. The Hong Kong College of Obstetricians and Gynaecologists (HKCOG). Guidelines for the administration of hormone replacement therapy. Number 2. HKCOG. Jan 2003. https://hkcog.org.hk.
  36. Woolf AD. An update on glucocorticoid-induced osteoporosis. Curr Opin Rheumatol. 2007 Jul;19(4):370-375. http://www.ncbi.nlm.nih.gov/. PMID: 17551369
  37. Watts NB, Bilezikian JP, Camacho PM, et al. American Association of Clinical Endocrinologists. Medical guidelines for clinical practice for the diagnosis and treatment of postmenopausal osteoporosis. 2010. Endocr Pract. 2010 Dec;16(Suppl 3):1-37. http://www.ncbi.nlm.nih.gov/pubmed/. PMID: 21224201
  38. North American Menopause Society (NAMS). Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause. 2010 Jan;17(1):25-54. http://www.ncbi.nlm.nih.gov/pubmed. PMID: 20061894
  39. MedWormhttp://www.medworm.com/rss/index.php/Endocrinology/15/http://www.medworm.com/rss/medicalfeeds/specialities/Endocrinology.xml
  40. MedWormhttp://www.medworm.com/rss/index.php/OBGYN/29/http://www.medworm.com/rss/medicalfeeds/specialities/OBGYN.xml
  41. Ministry of Health Malaysia, Academy of Medicine Malaysia, Malaysian Osteoporosis Society. Clinical guidelines on management of osteoporosis 2012. Malaysian Osteoporosis Society. http://www.osteoporosis.my. 2012. Accessed 18 Jun 2013.
  42. Finkelstein JS. Clinical manifestations, diagnosis, and evaluation of osteoporosis in men. UpToDate. http://www.uptodate.com/. 2010. Accessed 11 Jan 2011.
  43. Malaysian Osteoporosis Society, Academy of Medicine Malaysia. Clinical practice guidelines of management of osteoporosis. Malaysian Osteoporosis Society. http://www.osteoporosis.my/. 2012. Accessed 11 Jun 2013.
  44. Ministry of Health (MOH) Singapore. Clinical practice guidelines: osteoporosis. MOH Singapore. http://www.moh.gov.sg. 2008. Accessed 26 May 2010.
  45. National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. NOF. http://nof.org/. 2013.
  46. Schnitzer TJ. Diagnosis and treatment for osteoporosis: current status and expectations for the new millennium. Medscape. http://www.medscape.com/. Dec 2001.
  47. Finkelstein JS. Diagnosis and evaluation of osteoporosis in men. UpToDate. http://www.uptodate.com/. 2010. Accessed 11 Jan 2011.
  48. National Osteoporosis Foundation. Foundation for Osteoporosis Research and Education: osteoporosis guidelines for the physician. 4th ed. NOF. http://www.nof.org. 2002.
  49. Compston J, Barlow D, et al; Guidelines Working Group the Royal College of Physicians, The Bone Tooth Society of Great Britain and The National Osteoporosis Society. Glucocorticoid-induced osteoporosis: guidelines for prevention and treatment. Royal College of Physicians. http://www.rcplondon.ac.uk. Dec 2002.
  50. National Osteoporosis Guideline Group and the International Osteoporosis Foundation. Guidelines in practice. The University of Sheffield. http://shef.ac.uk/. 2009. Accessed 28 Sep 2011.
  51. Reginster JY. New agents for the treatment of osteoporosis. Medscape. http://www.medscape.com. Jan 2003.
  52. Osteoporosis prevention, diagnosis and therapy. National Institute of Health (NIH) consensus statement. Mar 27-29, 2000:1-36. http://www.opd.od.nih.gov.
  53. Finkelstein JS. Overview of osteoporosis in men. UpToDate. http://www.uptodate.com. 2003.
  54. National Institute for Health and Care Excellence (NICE). Osteoporosis: assessing the risk of fragility fracture. NICE. http://www.nice.org.uk. Aug 2012. Accessed 11 Jun 2013.
  55. Rosen HN, Saag KG. Prevention and treatment of glucocorticoid-induced osteoporosis. UpToDate. https://www.uptodate.com. May 2011. Accessed 22 Sep 2011.
  56. Lie D. Prevention and treatment of osteoporosis in long-term glucocorticoid users. Medscape. http://www.medscape.com. Aug 2002.
  57. Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-1822. doi: 10.1210/jc.2011-3045. PMID: 22675062
  58. Compston J, Bowring C, Cooper A, et al; National Osteoporosis Guideline Group. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas. 2013 Aug;75(4):392-396. doi: 10.1016/j.maturitas.2013.05.013. PMID: 23810490
  59. OSHK Task Group for Formulation of 2013 OSHK Guideline for Clinical Management of Postmenopausal Osteoporosis in Hong Kong, Ip I, Cheung SK, Cheung TC, et al; Osteoporosis Society of Hong Kong. The Osteoporosis Society of Hong Kong (OSHK): 2013 OSHK guideline for clinical management of postmenopausal osteoporosis in Hong Kong. Hong Kong Med J. 2013 Apr;19(Suppl 2):1-40. http://www.hkmj.org. Accessed 22 May 2014. PMID: 23535738
  60. Malaysian Osteoporosis Society, Academy of Medicine Malaysia, and Ministry of Health Malaysia. Clinical guidance on management of osteoporosis 2012. Revised 2015. Malaysian Society of Rheumatology (MSR). http://www.msr.my. 2015. Accessed 04 Sep 2015.
  61. Kanis JA, McCloskey EV, Johansson H, et al; Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013 Jan;24(1):23-57. http://www.ncbi.nlm.nih.gov. Accessed 02 Oct 2014. PMID: 23079689
  62. Li-Yu J, Perez EC, Canete A, et al; Osteoporosis Society of the Philippines Foundation Inc, Philippine Orthopedic Association Clinical Practice Guidelines Task Force Committee on Osteoporosis. Summary of the consensus statements on osteoporosis prevention, diagnosis, and treatment in the Philippines. Journal of ASEAN Federation of Endocrine Societies. http://www.asean-endocrinejournal.org/. 2012.
  63. Qaseem A, Forciea MA, McLean RM, et al; Clinical Guidelines Committee of the American College of Physicians. Treatment of low bone density or osteoporosis to prevent fractures in men and women; a clinical practice guideline update from the American College of Physicians. Ann Intern Med. 2017 Jun 6;166(11):818-839. doi: 10.7326/M15-1361. Accessed 27 Jun 2017. PMID: 28492856
  64. Hauk L. Treatment of low BMD and osteoporosis to prevent fractures: updated guideline from the ACP. Am Fam Physician. 2018 Mar 1;97(5):352-353. https://www.aafp.org. Accessed 14 Aug 2018. PMID: 29671503
  65. Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016 Jan;31(1):16-35. doi: 10.1002/jbmr.2708. Accessed 6 Dec 2016. PMID: 26350171
  66. Jeremiah MP, Unwin BK, Greenawald MH, et al. Diagnosis and management of osteoporosis. Am Fam Physician. 2015 Aug;92(4):261-268. http://www.aafp.org. Accessed 6 Dec 2016. PMID: 26280231
  67. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-2381. doi: 10.1007/s00198-014-2794-2. Accessed 2 Oct 2014. PMID: 25182228
  68. Tu KN, Lie JD, Wan CKV, et al. Osteoporosis: a review of treatment options. P T. 2018 Feb;43(2):92-104. Accessed 07 Jan 2019. PMID: 29386866
  69. Finkelstein JS, Yu EW. Treatment of osteoporosis in men. UpToDate. https://www.uptodate.com/. Dec 2018. Accessed 07 Jan 2019.
  70. Rosen HN. Selective estrogen receptor modulators for prevention and treatment of osteoporosis. UpToDate. https://www.uptodate.com/. Dec 2018. Accessed 07 Jan 2019.
  71. Rosen HN, Drezner MK. Overview of the management of osteoporosis in postmenopausal women. UpToDate. https://www.uptodate.com/. Dec 2018. Accessed 07 Jan 2019.
  72. Papaioannou A, Morin S, Cheung AM, et al. 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010 Nov;182(17):1864-1873. doi: 10.1503/cmaj.100771. PMID: 20940232
  73. Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019 May;104(5):1595-1622. doi: 10.1210/jc.2019-00221. Accessed 23 May 2019. PMID: 30907953
  74. Shoback D, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society guideline update. J Clin Endocrinol Metab. 2020 Mar 1;105(3):pii:dgaa048. doi: 10.1210/clinem/dgaa048. Accessed 17 Mar 2020. PMID: 32068863
  75. Bethel M. Osteoporosis. Medscape. https://emedicine.medscape.com. 26 Sep 2019. Accessed 07 Jul 2020.
  76. Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol. 2017 Aug;69(8):1521-1537. doi: 10.1002/art.40137. Accessed 07 Jul 2020. PMID: 28585373
  77. Diez-Perez A, Adachi JD, Agnusdei D, et al; IOF CSA Inadequate Responders Working Group. Treatment failure in osteoporosis. Osteoporos Int. 2012 Dec;23(12):2769-2774. doi: 10.1007/s00198-012-2093-8. Accessed 07 Jul 2020. PMID: 22836278
  78. Straseski JA. Osteoporosis. ARUP Consult. https://arupconsult.com/content/osteoporosis. Jan 2020. Accessed 07 Jul 2020.
  79. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract. 2020 May;26(Suppl 1):1-46. doi: 10.4158/GL-2020-0524SUPPL. Accessed 02 Sep 2020. PMID: 32427503
  80. The Royal Australian College of General Practitioners and Osteoporosis Australia. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd ed. East Melbourne, Vic: RACGP, 2017. Royal Australian College of General Practitioners. https://www.racgp.org.au. Accessed 25 Sep 2020
  81. Chandran M, Mitchell PJ, Amphansap T, et al. Asia Pacific Consortium on Osteoporosis (APCO). Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region. Osteoporos Int. 2021 Jul;32(7):1249-1275. doi: 10.1007/s00198-020-05742-0. Accessed 07 Apr 2021. PMID: 33502559
  82. Scottish Intercollegiate Guidelines Network (SIGN). SIGN publication no. 142. Management of osteoporosis and the prevention of fragility fractures. SIGN. http://www.sign.ac.uk. Jan 2021. Accessed 07 Apr 2021.
  83. Kwok TCY, Law SW, Leung EMF, et al. Hip fractures are preventable: a proposal for osteoporosis screening and fall prevention in older people. Hong Kong Med J. 2020 Jun;26(3):227-235. doi: 10.12809/hkmj198337. Accessed 08 Jul 2021. PMID: 32554817
  84. Diab DL, Watts NB. Updates on osteoporosis in men. Endocrinol Metab Clin North Am. 2021 Jun;50(2):239-249. doi: 10.1016/j.ecl.2021.03.001. PMID: 34023041
  85. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021 Sep 1;28(9):973-997. doi: 10.1097/GME.0000000000001831. Accessed 10 Sep 2021. PMID: 34448749
  86. National Osteoporosis Guideline Group on behalf of the Bone Research Society, British Geriatrics Society, British Orthopaedic Association, British Orthopaedics Research Society, British Society of Rheumatology, National Osteoporosis Society, Osteoporosis 2000, Osteoporosis Dorset, Primary Care Rheumatology Society, Royal College of Physicians and Society for Endocrinology. Osteoporosis: clinical guideline for prevention and treatment. Executive summary. The University of Sheffield. http://www.shef.ac.uk. Mar 2014.
  87. Rosen HN. Calcitonin in the prevention and treatment of osteoporosis. UpToDate. https://www.uptodate.com. Dec 2018. Accessed 07 Jan 2019.
  88. American College of Rheumatology (ACR). 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis guideline summary. ACR. https://www.rheumatology.org/. 09 Nov 2022. Accessed 17 Nov 2022.
  89. Ministry of Health (MOH) Malaysia, Academy of Medicine Malaysia, Malaysian Osteoporosis Society. Clinical practice guidelines management of osteoporosis 2022 (3rd ed). MOH. https://www.moh.gov.my/. 2022. Accessed 17 Nov 2022.
  90. Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, et al. Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: a living clinical guideline from the American College of Physicians. 2023 Feb;176(2):224-238. doi: 10.7326/M22-1034. PMID: 36592456
Editor's Recommendations
Special Reports
MORE Special Reports arrow
Related Disease News
MORE Disease News arrow