Optimal Management of Osteoporosis Across Age Groups

Foundation for All Age Groups

The American College of Rheumatology recommends that all patients receive lifestyle modifications including adequate calcium intake, vitamin D supplementation, regular weight-bearing exercise, smoking cessation, and limiting alcohol to ≤2 servings per day 1, 3, 4
Fracture risk assessment should include clinical fracture history, BMD testing, and for patients ≥40 years, FRAX calculation 1, 4
BMD testing with vertebral fracture assessment (VFA) or spinal X-rays should be performed every 1-2 years to monitor treatment response 3, 4

The American College of Rheumatology recommends oral bisphosphonates as first-line treatment for adults ≥40 years with high or very high fracture risk due to their established efficacy in reducing vertebral and hip fractures, safety profile, and cost-effectiveness 1, 2, 5
For very high-risk patients, anabolic agents like teriparatide should be considered over antiresorptive agents 1, 3

The American College of Internal Medicine recommends considering stopping bisphosphonate treatment after 5 years unless there's a strong indication for continuation, as longer treatment reduces vertebral fractures but increases risk of long-term adverse effects 2, 5
For patients initially treated with anabolic agents, transition to an antiresorptive agent after discontinuation to preserve bone gains and prevent rebound bone loss 2, 5

For glucocorticoid-induced osteoporosis, FRAX calculations should be adjusted upward (multiply by 1.15 for major osteoporotic fracture risk and by 1.2 for hip fracture risk) 4
For older adults (>65 years), consider polypharmacy, fall risk, and drug interactions when selecting treatment 2, 5