Diagnosis of osteoporosis in postmenopausal women

BMD: bone mineral density; DXA: dual-energy x-ray absorptiometry; FRAX: Fracture Risk Assessment Tool.

* Fragility fractures are those occurring spontaneously or from minor trauma (eg, a fall from a standing height or less).The most common sites of fragility fracture are the spine (vertebral compression fractures), hip, and wrist. Fragility fractures also occur at the humerus, rib, and pelvis.

¶ Some individuals with osteoporosis are at very high risk of fracture. No consensus exists on the definition of very high fracture risk. Examples may include:

• Severe or multiple fractures
• T-score ≤–2.5 plus a fragility fracture
• T-score ≤–3.0

Δ When the hip or lumbar spine cannot be measured due to structural abnormalities (eg, osteoarthritis), the 33% (one-third) radius can be measured and considered for diagnostic classification.

◊ We use FRAX to calculate absolute risk of fracture. In the United States, high risk is defined as a 10-year probability of:

• Hip fracture ≥3%
• or
• Combined major osteoporotic fracture (ie, clinical vertebral, hip, forearm, or proximal humerus) ≥20%

FRAX risk thresholds are country specific. For clinicians practicing outside of the United States, intervention thresholds may be accessed directly from the FRAX website.