Osteoporosis Risk Assessment
Identify candidates for bone density testing
All Pathways
Family MedicineDiagnostic
Osteoporosis Screening & Management (USPSTF/NOF)
Osteoporosis Screening & Management (USPSTF/NOF): Osteoporosis Risk Assessment → USPSTF Screening Criteria → Risk Factor Assessment → DXA Bone Density →...
Pathway Overview
12 steps
Algorithm Steps
12 total
01Start 02Decision USPSTF Screening Criteria
Who should be screened
- Women ≥65 years: Screen all
- Postmenopausal women <65: Screen if 10-year fracture risk ≥ 65-year-old white woman (FRAX ~9.3%)
- Men: No universal recommendation; consider if risk factors
03Action Risk Factor Assessment
Identify increased risk
- Advanced age, female sex
- Low body weight (<127 lbs)
- Current smoking, excess alcohol
- Personal or parental hip fracture
- Glucocorticoid use (≥3 months)
- Rheumatoid arthritis, secondary causes
04Action DXA Bone Density
Central DXA of hip and spine
- Measure femoral neck and lumbar spine
- Use lowest T-score for diagnosis
- Report T-score (postmenopausal/men ≥50)
- Report Z-score (premenopausal/men <50)
05Decision T-Score Classification
WHO criteria
- Normal: T-score ≥ -1.0
- Osteopenia: T-score -1.0 to -2.5
- Osteoporosis: T-score ≤ -2.5
06Outcome Normal Bone Density
Reassess in 10-15 years; lifestyle counseling
07Action Osteopenia
Calculate 10-year fracture risk
- Use FRAX calculator
- Treat if: Hip fracture risk ≥3% OR major osteoporotic fracture risk ≥20%
- Otherwise: lifestyle, rescreen 2-5 years
08Action Pharmacologic Treatment
First-line agents
- Alendronate 70mg weekly or 10mg daily
- Risedronate 150mg monthly or 35mg weekly
- Zoledronic acid 5mg IV yearly
- Take with water, remain upright 30-60 min
- Ensure adequate Ca (1000-1200mg) and Vit D (800-1000 IU)
09Action Treatment Monitoring
Follow-up strategy
- Repeat DXA 1-2 years after starting treatment
- Stable or improved = continue
- Consider drug holiday after 5 years oral / 3 years IV if not high risk
- Reassess fracture risk annually
10Warning Osteoporosis
Initiate treatment
- T-score ≤ -2.5 at any site
- OR prior fragility fracture (clinical osteoporosis)
- Secondary workup: Ca, Vit D, PTH, TSH, CBC, CMP
- Path rejoins step 08Shared downstream outcome
11Action Very High Risk Options
Anabolic agents first
- Consider if: T-score ≤ -3.0, multiple fractures, very high FRAX
- Romosozumab 210mg SQ monthly x 12 months
- Teriparatide 20mcg SQ daily x 2 years
- Must follow with bisphosphonate
- Path rejoins step 08Shared downstream outcome
12Action Lifestyle Measures (All)
Non-pharmacologic interventions
- Weight-bearing exercise
- Fall prevention assessment
- Smoking cessation
- Limit alcohol (<3 drinks/day)
- Calcium 1000-1200mg, Vit D 800-2000 IU daily
- Path rejoins step 04Shared downstream outcome
Guideline Source
USPSTF Osteoporosis Screening Recommendation + NOF Guidelines
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- FRAX calculator inputs simplified
- Treatment duration decisions require specialist input
- Atypical femur fracture monitoring not detailed
- Secondary osteoporosis workup abbreviated
- Medication holiday criteria simplified
Applicable Regions
USAUUKEU
AU: RACGP recommends DXA for at-risk individuals
UK: NICE uses FRAX for fracture risk assessment
US: USPSTF Grade B for women ≥65 or younger at increased risk
Version 1Next review: 2028-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Osteoporosis Screening & Management (USPSTF/NOF)?
The Osteoporosis Screening & Management (USPSTF/NOF) is a diagnostic clinical algorithm for Family Medicine. It provides a structured decision tree to guide clinical decision-making, based on USPSTF Osteoporosis Screening Recommendation + NOF Guidelines.
What guideline is the Osteoporosis Screening & Management (USPSTF/NOF) based on?
This algorithm is based on USPSTF Osteoporosis Screening Recommendation + NOF Guidelines (DOI: 10.1001/jama.2018.19986).
What are the limitations of the Osteoporosis Screening & Management (USPSTF/NOF)?
Known limitations include: FRAX calculator inputs simplified; Treatment duration decisions require specialist input; Atypical femur fracture monitoring not detailed; Secondary osteoporosis workup abbreviated; Medication holiday criteria simplified. Individual patient factors may require deviation from these recommendations.
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