Version July 2025
BMD: bone mineral density; CTX: C-telopeptide; DXA: dual-energy x-ray absorptiometry; IV: intravenous; LSC: least significant change.
* Inadequate absorption is often related to insufficient time interval between drug intake and food or calcium ingestion.
¶ A change in BMD is considered significant if it exceeds the LSC for the specific densitometer used. If LSC is not reported, a simplified approximation for exceeding LSC is ≥5%.
Δ 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.
◊ There are many disorders/drugs with adverse skeletal effects. Clinical findings guide the evaluation for a specific concurrent disorder (eg, incident hypercalcemia may indicate primary hyperparathyroidism).
§ If lack of response is related to poor absorption, switching to an IV bisphosphonate should result in an improvement in BMD.
¥ Increased risk of vertebral fracture is evident after discontinuation of denosumab, so the need for either indefinite treatment or transition to another osteoporosis medication should be addressed with patients before denosumab initiation.