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Osteoporotic fractures, especially hip fractures, are associated with mobility limitations, chronic disability, loss of independence, and reduced quality of life.
Several randomized trials have demonstrated the benefit of drug treatment in reducing clinical fractures among postmenopausal women with existing vertebral fractures or bone mineral density (BMD) T-scores of −2.5 or lower and among adults aged 50 years and older with recent hip fracture.
Thus, osteoporosis in the clinical setting should be diagnosed in patients with a history of hip or clinical vertebral fracture not due to excessive trauma, those with existing radiographic vertebral fractures, and those with a BMD T-score of −2.5 or lower at the hip (femoral neck or total hip) or lumbar spine. In the absence of a history of hip or vertebral fracture, osteoporosis screening is aimed at identifying individuals with a BMD T-score of −2.5 or lower because those individuals may be candidates for osteoporosis pharmacotherapy. The BMD T-score quantifies the difference (expressed in standard deviations) between a patient’s BMD and the average BMD of young adult white women (reference group).
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Corresponding Author: Carolyn J. Crandall, MD, MS, David Geffen School of Medicine at University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave, Ste 850 - Room 858, Los Angeles, CA 90024 (firstname.lastname@example.org).
Published Online: January 9, 2020. doi:10.1001/jama.2019.18343
Conflict of Interest Disclosures: Dr Ensrud reported receiving grants from Merck & Co outside the submitted work. No other disclosures were reported.
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