Osteoporosis Quick Reference Guide - UCSF Fresno
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Quick Reference Guide
2-2021 version
Osteoporosis
Soe Naing, MD, MRCP(UK), FACE, ECNU
Professor of Medicine
Director of Division of Endocrinology
Medical Director of Community Diabetes Education Center
University of California, San Francisco
Fresno Medical Education Program
For digital copy, please visit
http://www.fresno.ucsf.edu/internal-medicine/endo_downloads/ or
email soe.naing@ucsf.edu.
Naing/ 2-2021
American Association of Clinical Endocrinologists. Clinical Practice Guidelines for the Diagnosis and Treatment of
Postmenopausal Osteoporosis - 2020 Update
https://www.aace.com/disease-state-resources/bone-and-parathyroid/clinical-practice-guidelines/clinical-practice
Naing/ 2/2021
1
The World Health Organization (WHO) has also defined osteoporosis based on dual-energy
x-ray absorptiometry (DXA) measurements.
T-scores are calculated by comparing a specific value with a normative reference range for patients
of the same gender and ethnicity. The T-score is the number of standard deviations (SD) below
young adult normal values. Clinically, usually three regions are used for diagnosis: BMD at the total
hip, the femoral neck, and the lumbar spine. DXA values at the hip generally peak at about age 30
to 40 years and then begin to decline. The decline is somewhat accelerated at menopause for a few
years and then becomes accelerated again after about age 65 or 70 years in women.
Osteoporosis: Screening, Prevention, and Management 2
Med Clin N Am 99 (2015) 587–606 http://dx.doi.org/10.1016/j.mcna.2015.01.010
Naing/ 2/2021
T-score vs Z-score
It has become standard practice to relate the results to “normal” values by using T-scores
(a T-score of 1 equals 1 SD), which compare individual results to those in a young adult
population that is matched for race and sex.
Z-scores (also measured in SD) compare individual results to those of an age-matched
population that also is matched for race and sex.
Thus, a 60-year-old woman with a Z-score of –1 (1 SD below mean for age) has a T-score
of –2.5 (2.5 SD below mean for a young control group)
https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9
The FRAX® tool has been developed to evaluate fracture risk of patients.
The FRAX® algorithms give the 10-year probability of hip fracture and the 10-year probability of a major osteoporotic
fracture (clinical spine, forearm, hip or shoulder fracture).
Consider FDA-approved medical therapies in postmenopausal women and men aged 50 years and older,
based on the following:
• A hip or vertebral fragility fracture (clinical or morphometric)
• T-score ≤ -2.5 at the femoral neck or spine after appropriate evaluation to exclude secondary causes
• Osteopenia (T-score between -1.0 and -2.5 at the femoral neck or spine) and a 10-year probability of a hip
fracture ≥ 3% or a 10-year probability of a major osteoporosis-related fracture ≥ 20% based on FRAX score
3
Naing/ 2/2021
Pathogenesis of osteoporosis-related fractures,
National Ostoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis.
Osteoporos Int (2014) 25:2359–2381 DOI 10.1007/s00198-014-2794-2
4
Naing/ 2/2021
National Ostoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis.
Osteoporos Int (2014) 25:2359–2381 DOI 10.1007/s00198-014-2794-2
National Ostoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis.
Osteoporos Int (2014) 25:2359–2381 DOI 10.1007/s00198-014-2794-2
5
Naing/ 2/2021
6 Naing/ 2/2021
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https://link.springer.com/article/10.1007/s00467-019-04271-1#Fig1
Naing/ 2/2021
8 Naing/ 2/2021
Total testosterone and gonadotropin in younger men
Osteoporosis: Screening, Prevention, and Management 9
Med Clin N Am 99 (2015) 587–606 http://dx.doi.org/10.1016/j.mcna.2015.01.010
Naing/ 2/2021Osteoporosis: Screening, Prevention, and Management
Med Clin N Am 99 (2015) 587–606 http://dx.doi.org/10.1016/j.mcna.2015.01.010
10
Naing/ 2/2021Osteoporosis: Screening, Prevention, and Management
Med Clin N Am 99 (2015) 587–606 http://dx.doi.org/10.1016/j.mcna.2015.01.010
11
Naing/ 2/2021American Association of Clinical Endocrinologists. Clinical Practice Guidelines for the Diagnosis and Treatment of
Postmenopausal Osteoporosis - 2020 Update
https://www.aace.com/disease-state-resources/bone-and-parathyroid/clinical-practice-guidelines/clinical-practice
12
Naing/ 2/2021Pharmacological Management of Osteoporosis in Postmenopausal Women:
An Endocrine Society Guideline Update. 2020
https://www.endocrine.org/clinical-practice-guidelines/osteoporosis-in-postmenopausal-women
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Naing/ 2/202114 Naing/ 2/2021
15 Naing/ 2/2021
https://www.endocrine.org/clinical-practice-guidelines/osteoporosis-in-postmenopausal-women
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Naing/ 2/2021Additional/Optional reading
(Advanced level)
Bone biomarker for the clinical assessment of osteoporosis
https://biomarkerres.biomedcentral.com/articles/10.1186/s40364-017-0097-4#Sec1
17
Naing/ 2/2021https://journals.sagepub.com/doi/pdf/10.1177/0192623318779565
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Naing/ 2/202119 Naing/ 2/2021
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