Osteoporosis Treatment Indications

Diagnostic Criteria

• The presence of a vertebral fracture with a height loss of 25% (wedging chronic T12) establishes the diagnosis of osteoporosis, even without considering the T-score, according to the World Health Organization criteria 1, 2
• A T-score of -2.5 corresponds exactly to the diagnostic threshold of osteoporosis, as defined by the World Health Organization 1, 2

Indications for Immediate Treatment

• The American College of Radiology recommends that a vertebral fracture is the most powerful predictor of future fractures, multiplying the risk of new vertebral fractures by 5 and the risk of fractures at other sites by 2-3, thus requiring immediate treatment 3, 4, 2
• The presence of a vertebral fracture automatically reclassifies the patient as having established osteoporosis, requiring treatment, regardless of FRAX scores 4, 2

Recommended Therapeutic Options

• The World Health Organization recommends denosumab 60 mg subcutaneously every 6 months as an alternative treatment if bisphosphonates are contraindicated or not tolerated 1
• Denosumab reduces the risk of vertebral fractures (RR 0.32), non-vertebral fractures (RR 0.80), and hip fractures (RR 0.60) 1

Mandatory Supplementation

• The National Osteoporosis Foundation recommends that all patients treated for osteoporosis should receive calcium supplementation (1000-1200 mg per day) and vitamin D supplementation (800-1000 IU per day) 1, 5, 3

Monitoring of Treatment

• The American College of Radiology recommends repeating DEXA scans every 1-2 years on the same device to evaluate the response to treatment 4, 5
• Compare the bone mineral density values (not T-scores) between exams 4