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Osteoporosis

Nearly 4 million fractures occur in U.S. adults age 50 and over each year.¹ These fractures can impair mobility and decrease independence. Having one fracture increases the likelihood of having another.² Even older patients whose fractures follow trauma are likelier to have low bone density. Clinicians should help identify patients with low bone mineral density and recommend treatment to reduce the chances of a subsequent fracture if needed.

Spine and hip fractures: Go straight to treatment

Either one of these fractures indicates osteoporosis. Treatment is indicated without requiring a scan to assess bone mineral density.

Lower-risk fractures: Assess DXA first

A dual-energy x-ray absorptiometry (DXA) scan assesses bone mineral density, categorizing patients using a T-score. The T-score compares bone mineral density to that of a young, healthy adult.

Bone mineraldensity based on T-score

Image of normal bone, which has a T-score of more than -1; osteopenia which has a T-score of -1 to -2.5, and osteoporosis which has a T-score of less than -2.5.

Using the T-score to determine next steps³

normal bone: no treatment required
osteopenia: depends on the fracture
- pelvic, proximal humerous, or wrist fractures require treatment with a bisphosphonate
- for other lower-risk fractures, a FRAX score (FRAXplus.org) may help determine if treatment is needed
osteoporosis: treat with a bisphosphonate

Planning for treatment

Bisphosphonates are preferred for most patients. Oral options include alendronate, risedronate, and ibandronate. Intravenous options (IV) include zoledronic acid and ibandronate.

Treatment is not lifelong

Oral bisphosphonates are typically prescribed for five years, with IV bisphosphonates prescribed for three years. An extended treatment duration may be preferred for some patients based on their response to treatment.

Bisphosphonates are safe and effective^4-7

$For every 10,000 people treated with bisphosphonates, 270 vertebral fractures, 280 non-vertebral fractures, 179 wrist fractures, and 100 hip fractures are prevented. Side effects are uncommon. Among 10,000 patients, 30 will have gastrointestinal side effects, 5 may have an atypical femoral fracture, and 1 may have osteonecrosis of the jaw.$

Encourage overall bone health³

Ensure adequate calcium intake
- Typically four servings for a total of 1,200 mg consumed each day.
Check vitamin D levels
- Usual levels are between 30-50 ng/mL.
- Supplementation may be needed for low levels.
Exercise using a combination of resistance and weight bearing movements.
Limit alcohol intake and stop smoking

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Information current at time of publication, June 2026.

The content of this website is educational in nature and includes general recommendations only; specific medical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

Amin S, et al. Trends in fracture incidence: a population-based study over 20 years. J Bone Miner Res. 2014;29(3):581-589.
Cosman F, et al. Goal-directed osteoporosis treatment: ASBMR/BHOF task force position statement 2024. J Bone Miner Res. 2024;39(10):1393-1405.
Camacho PM, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Udate. Endocr Pract. 2020;26(Suppl 1):1-46.
Bauer DC, et al. Upper Gastrointestinal Tract Safety Profile of Alendronate: The Fracture Intervention Trial. Arch Intern Med. 2000;160(4):517-525.
Khan AA, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015;30(1):3-23.
Shane E, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29(1):1-23.
Wells GA, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2025;1(1):Cd001155.