Osteoporosis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Osteoporosis is asymptomatic until fracture occurs.
Diagnosis is based on a history of prior fragility fracture or low bone mineral density, which is defined as a T-score ≤-2.5.
Screening is based on individual risk factors, including female sex, maternal history of fragility fracture/osteoporosis, older age, low body mass index (<20 kg/m²), androgen deprivation treatment (in males), aromatase inhibitor treatment (in females), corticosteroid use, tobacco use, and excessive alcohol intake.
Adequate calcium and vitamin D intake is recommended for all patients. Bisphosphonates are first-line pharmacologic therapy for postmenopausal women and men.
All patients treated with teriparatide, abaloparatide, denosumab, or romosozumab should receive sequential therapy with antiresorptive osteoporosis treatment to prevent rapid bone loss.

Chest x-ray showing marked deformity and volume loss of bony thorax in a patient with osteoporosis

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Definition

Epidemiology

Etiology

Pathophysiology

Images

Chest x-ray showing marked deformity and volume loss of bony thorax in a patient with osteoporosis

Citations

Key Articles

ACOG Committee on Clinical Practice Guidelines-Gynecology. Osteoporosis prevention, screening, and diagnosis: ACOG clinical practice guideline no. 1. Obstet Gynecol. 2021 Sep 1;138(3):494-506.[Abstract][Full Text]
LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.[Abstract][Full Text]
ACOG Committee on Clinical Practice Guidelines-Gynecology. Management of postmenopausal osteoporosis: ACOG clinical practice guideline no. 2. Obstet Gynecol. 2022 Apr 1;139(4):698-717.[Abstract]
Humphrey MB, Russell L, Danila MI, et al. 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol. 2023 Dec;75(12):2088-102.[Abstract][Full Text]
Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595-622.[Abstract][Full Text]

Other Online Resources

BMJ talk medicine podcast: osteoporosis
NIH: calcium and vitamin D - important at every age

Referenced Articles

1. Consensus development conference: diagnosis, prophylaxis and treatment of osteoporosis. Am J Med. 1993 Jun;94(6):646-50.[Abstract]
2. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001 Feb 14;285(6):785-95.[Abstract]
3. WHO Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: report of a WHO scientific group. (WHO technical report series: 921.) Geneva, Switzerland: WHO; 2000.[Full Text]
4. Harvey N, Dennison E, Cooper C. Osteoporosis: impact on health and economics. Nat Rev Rheumatol. 2010 Feb;6(2):99-105.[Abstract]
5. Salari N, Ghasemi H, Mohammadi L, et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021 Oct 17;16(1):609.[Abstract][Full Text]
6. Salari N, Darvishi N, Bartina Y, et al. Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021 Nov 13;16(1):669.[Abstract][Full Text]
7. Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017-2018. NCHS Data Brief. 2021 Mar;(405):1-8.[Abstract]
8. Cappola AR, Auchus RJ, El-Hajj Fuleihan G, et al. Hormones and aging: an Endocrine Society Scientific statement. J Clin Endocrinol Metab. 2023 Jul 14;108(8):1835-74.[Abstract][Full Text]
9. Wade SW, Strader C, Fitzpatrick LA, et al. Estimating prevalence of osteoporosis: examples from industrialized countries. Arch Osteoporos. 2014;9:182.[Abstract]
10. Zamani M, Zamani V, Heidari B, et al. Prevalence of osteoporosis with the World Health Organization diagnostic criteria in the Eastern Mediterranean Region: a systematic review and meta-analysis. Arch Osteoporos. 2018 Nov 17;13(1):129.[Abstract]
11. Manolagas SC. Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr Rev. 2000 Apr;21(2):115-37.[Abstract][Full Text]
12. Manolagas SC. Cell number versus cell vigor: what really matters to a regenerating skeleton? Endocrinology. 1999 Oct;140(10):4377-81.[Abstract][Full Text]
13. Turner CH, Robling AG, Duncan RL, et al. Do bone cells behave like a neuronal network? Calcif Tissue Int. 2002 Jun;70(6):435-42.[Abstract]
14. Suda T, Takahashi N, Martin TJ. Modulation of osteoclast differentiation. Endocr Rev. 1992 Feb;13(1):66-80.[Abstract]
15. Zerwekh JE, Sakhaee K, Breslau NA, et al. Impaired bone formation in male idiopathic osteoporosis: further reduction in the presence of concomitant hypercalciuria. Osteoporos Int. 1992 May;2(3):128-34.[Abstract]
16. Sakhaee K, Maalouf NM, Kumar R, et al. Nephrolithiasis-associated bone disease: pathogenesis and treatment options. Kidney Int. 2011 Feb;79(4):393-403.[Abstract][Full Text]
17. Kostenuik PJ. Osteoprotegerin and RANKL regulate bone resorption, density, geometry and strength. Curr Opin Pharmacol. 2005 Dec;5(6):618-25.[Abstract]
18. Boyle WJ, Simonet WS, Lacey DL. Osteoclast differentiation and activation. Nature. 2003 May 15;423(6937):337-42.[Abstract]
19. Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet. 1996 Dec 7;348(9041):1535-41.[Abstract]
20. Cummings SR, Black DM, Thompson DE, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA. 1998 Dec 23-30;280(24):2077-82.[Abstract]
21. Dennison E, Eastell R, Fall CH, et al. Determinants of bone loss in elderly men and women: a prospective study. Osteoporos Int. 1999;10(5):384-91.[Abstract]
22. Burger H, de Laet CE, van Daele PL, et al. Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol. 1998 May 1;147(9):871-9.[Abstract]
23. Liu H, Paige NM, Goldzweig CL, et al. Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline. Ann Intern Med. 2008 May 6;148(9):685-701.[Abstract][Full Text]
24. ACOG Committee on Clinical Practice Guidelines-Gynecology. Osteoporosis prevention, screening, and diagnosis: ACOG clinical practice guideline no. 1. Obstet Gynecol. 2021 Sep 1;138(3):494-506.[Abstract][Full Text]
25. Law MR, Hackshaw AK. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ. 1997 Oct 4;315(7112):841-6.[Abstract][Full Text]
26. Cheraghi Z, Doosti-Irani A, Almasi-Hashiani A, et al. The effect of alcohol on osteoporosis: a systematic review and meta-analysis. Drug Alcohol Depend. 2019 Apr 1;197:197-202.[Abstract]
27. Jackson RD, LaCroix AZ, Gass M, et al; Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006 Feb 16;354(7):669-83.[Abstract][Full Text]
28. Mazziotti G, Angeli A, Bilezikian JP, et al. Glucocorticoid-induced osteoporosis: an update. Trends Endocrinol Metab. 2006 May-Jun;17(4):144-9.[Abstract]
29. Liu J, Li X, Fan L, et al. Proton pump inhibitors therapy and risk of bone diseases: an update meta-analysis. Life Sci. 2019 Feb 1;218:213-23.[Abstract]
30. Lakatos P. Thyroid hormones: beneficial or deleterious for bone? Calcif Tissue Int. 2003 Sep;73(3):205-9.[Abstract]
31. Casele HL. The use of unfractionated heparin and low molecular weight heparins in pregnancy. Clin Obstet Gynecol. 2006 Dec;49(4):895-905.[Abstract]
32. Petty SJ, O'Brien TJ, Wark JD. Anti-epileptic medication and bone health. Osteoporos Int. 2007 Feb;18(2):129-42.[Abstract]
33. Wang A, Obertová Z, Brown C, et al. Risk of fracture in men with prostate cancer on androgen deprivation therapy: a population-based cohort study in New Zealand. BMC Cancer. 2015 Nov 2;15:837.[Abstract][Full Text]
34. Ross RW, Small EJ. Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol. 2002 May;167(5):1952-6.[Abstract]
35. Wright LE, Harhash AA, Kozlow WM, et al. Aromatase inhibitor-induced bone loss increases the progression of estrogen receptor-negative breast cancer in bone and exacerbates muscle weakness in vivo. Oncotarget. 2017 Jan 31;8(5):8406-19.[Abstract][Full Text]
36. Abdolalipour S, Mirghafourvand M. Effect of education on preventive behaviors of osteoporosis in adolescents: a systematic review and meta-analysis. Int Q Community Health Educ. 2021 Apr;41(3):325-47.[Abstract]
37. Rubæk M, Hitz MF, Holmberg T, et al. Effectiveness of patient education for patients with osteoporosis: a systematic review. Osteoporos Int. 2022 May;33(5):959-77.[Abstract]
38. Pinheiro MB, Oliveira J, Bauman A, et al. Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2020 Nov 26;17(1):150.[Abstract][Full Text]
39. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: US Preventive Services Task Force recommendation statement. JAMA. 2018 Apr 17;319(15):1592-9.[Abstract][Full Text]
40. Burt LA, Billington EO, Rose MS, et al. Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: a randomized clinical trial. JAMA. 2019 Aug 27;322(8):736-45.[Abstract][Full Text]
41. LeBoff MS, Chou SH, Ratliff KA, et al. Supplemental vitamin D and incident fractures in midlife and older adults. N Engl J Med. 2022 Jul 28;387(4):299-309.[Abstract][Full Text]
42. LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.[Abstract][Full Text]
43. Shi Y, Zhan Y, Chen Y, et al. Effects of dairy products on bone mineral density in healthy postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Arch Osteoporos. 2020 Mar 18;15(1):48.[Abstract]
44. Delmas PD, Bjarnason NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med. 1997 Dec 4;337(23):1641-7.[Abstract][Full Text]
45. Briot K, Roux C. Glucocorticoid-induced osteoporosis. RMD Open. 2015 Apr 8;1(1):e000014.[Abstract][Full Text]
46. Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022 Apr 5;17(1):58.[Abstract][Full Text]
47. Hsu E, Nanes M. Advances in treatment of glucocorticoid-induced osteoporosis. Curr Opin Endocrinol Diabetes Obes. 2017 Dec;24(6):411-7.[Abstract][Full Text]
48. Qaseem A, Forciea MA, McLean RM, et al. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med. 2017 Jun 6;166(11):818-39.[Abstract][Full Text]
49. Harvey NC, Odén A, Orwoll E, et al. Falls predict fractures independently of FRAX probability: a meta-analysis of the Osteoporotic Fractures In Men (MrOS) study. J Bone Miner Res. 2018 Mar;33(3):510-6.[Abstract][Full Text]
50. American College of Radiology. ACR appropriateness criteria: osteoporosis and bone mineral density. 2022 [internet publication].[Full Text]
51. ACOG Committee on Clinical Practice Guidelines-Gynecology. Management of postmenopausal osteoporosis: ACOG clinical practice guideline no. 2. Obstet Gynecol. 2022 Apr 1;139(4):698-717.[Abstract]
52. National Institute for Health and Care Excellence. Raloxifene and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. Feb 2018 [internet publication].[Full Text]
53. Adams J, Bishop N. DXA in adults and children. In: Rosen CJ, Compston JE, Lian JB, et al, eds. Primer on the metabolic bone diseases and disorders of mineral metabolism. 7th ed. Washington, DC: American Society for Bone and Mineral Research; 2008:152-8.
54. Fu Y, Li C, Luo W, et al. Fragility fracture discriminative ability of radius quantitative ultrasound: a systematic review and meta-analysis. Osteoporos Int. 2021 Jan;32(1):23-38.[Abstract][Full Text]
55. So E, Rushing C, Prissel MA, et al. The role of secondary imaging techniques for assessing bone mineral density in elderly ankle fractures. J Foot Ankle Surg. 2022 Jan-Feb;61(1):149-56.[Abstract]
56. Grados F, Fechtenbaum J, Flipon E, et al. Radiographic methods for evaluating osteoporotic vertebral fractures. Joint Bone Spine. 2009 May;76(3):241-7.[Abstract]
57. Cheng X, Wang L, Wang Q, et al. Validation of quantitative computed tomography-derived areal bone mineral density with dual energy X-ray absorptiometry in an elderly Chinese population. Chin Med J (Engl). 2014;127(8):1445-9.[Abstract]
58. Cann CE, Adams JE, Brown JK, et al. CTXA hip--an extension of classical DXA measurements using quantitative CT. PLoS One. 2014 Mar 17;9(3):e91904.[Abstract][Full Text]
59. Allende-Vigo MZ. The use of biochemical markers of bone turnover in osteoporosis. P R Health Sci J. 2007 Jun;26(2):91-5.[Abstract]
60. Vasikaran S, Eastell R, Bruyère O, et al. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int. 2011 Feb;22(2):391-420.[Abstract]
61. Royal Australian College of General Practitioners. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age: 2nd edition. 2017 [internet publication].[Full Text]
62. Cummings SR, Cawthon PM, Ensrud KE, et al. BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res. 2006 Oct;21(10):1550-6.[Abstract]
63. Moe S, Drüeke T, Cunningham J, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006 Jun;69(11):1945-53.[Abstract]
64. Humphrey MB, Russell L, Danila MI, et al. 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol. 2023 Dec;75(12):2088-102.[Abstract][Full Text]
65. US Preventive Services Task Force; Curry SJ, Krist AH, Owens DK, et al. Screening for osteoporosis to prevent fractures: US Preventive Services task force recommendation statement. JAMA. 2018 Jun 26;319(24):2521-31.[Abstract][Full Text]
66. Lim LS, Hoeksema LJ, Sherin K, et al. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med. 2009 Apr;36(4):366-75.[Abstract]
67. Merlijn T, Swart KMA, van der Horst HE, et al. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int. 2020 Feb;31(2):251-7.[Abstract][Full Text]
68. American College of Radiology. ACR appropriateness criteria: osteonecrosis. 2022 [internet publication].[Full Text]
69. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis: 2020 update. Endocr Pract. 2020 May;26(suppl 1):1-46.[Abstract][Full Text]
70. Watts NB, Adler RA, Bilezikian JP, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jun;97(6):1802-22.[Abstract][Full Text]
71. Liu C , Kuang X , Li K , et al. Effects of combined calcium and vitamin D supplementation on osteoporosis in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Food Funct. 2020 Dec 1;11(12):10817-27.[Abstract]
72. Bolland MJ, Leung W, Tai V, et al. Calcium intake and risk of fracture: systematic review. BMJ. 2015 Sep 29;351:h4580.[Abstract][Full Text]
73. Bolland MJ, Avenell A, Baron JA, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010 Jul 29;341:c3691.[Abstract][Full Text]
74. Bolland MJ, Grey A, Avenell A, et al. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis. BMJ. 2011 Apr 19;342:d2040.[Abstract][Full Text]
75. Lewis JR, Calver J, Zhu K, et al. Calcium supplementation and the risks of atherosclerotic vascular disease in older women: results of a 5-year RCT and a 4.5-year follow-up. J Bone Miner Res. 2011 Jan;26(1):35-41.[Abstract][Full Text]
76. Jamal SA, Moe SM. Calcium builds strong bones, and more is better - correct? Well, maybe not. Clin J Am Soc Nephrol. 2012 Nov;7(11):1877-83.[Abstract][Full Text]
77. Kitsuda Y, Wada T, Noma H, et al. Impact of high-load resistance training on bone mineral density in osteoporosis and osteopenia: a meta-analysis. J Bone Miner Metab. 2021 Sep;39(5):787-803.[Abstract]
78. Kunutsor SK, Leyland S, Skelton DA, et al. Adverse events and safety issues associated with physical activity and exercise for adults with osteoporosis and osteopenia: a systematic review of observational studies and an updated review of interventional studies. J Frailty Sarcopenia Falls. 2018 Dec;3(4):155-78.[Abstract][Full Text]
79. Kistler-Fischbacher M, Weeks BK, Beck BR. The effect of exercise intensity on bone in postmenopausal women (part 2): a meta-analysis. Bone. 2021 Feb;143:115697.[Abstract]
80. Segev D, Hellerstein D, Dunsky A. Physical activity: does it really increase bone density in postmenopausal women? A review of articles published between 2001-2016. Curr Aging Sci. 2018;11(1):4-9.[Abstract]
81. Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595-622.[Abstract][Full Text]
82. Rosenberg K. Bisphosphonates likely beneficial for most older women with osteoporosis. Am J Nurs. 2022 Apr 1;122(4):57.[Abstract]
83. Bilezikian JP. Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis. Am J Med. 2009 Feb;122(2 Suppl):S14-21.[Abstract]
84. Zhao S, Zhao W, Du D, et al. Effect of bisphosphonate on hip fracture in patients with osteoporosis or osteopenia according to age: a meta-analysis and systematic review. J Investig Med. 2022 Mar;70(3):837-43.[Abstract][Full Text]
85. Chesnut CH 3rd, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004 Aug;19(8):1241-9.[Abstract][Full Text]
86. Qaseem A, Hicks LA, Etxeandia-Ikobaltzeta I, et al. Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults: a living clinical guideline from the American College of Physicians. Ann Intern Med. 2023 Feb;176(2):224-38.[Abstract][Full Text]
87. Saito T, Sterbenz JM, Malay S, et al. Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int. 2017 Dec;28(12):3289-300.[Abstract]
88. Lee SY, Jung SH, Lee SU, et al. Can bisphosphonates prevent recurrent fragility fractures? A systematic review and meta-analysis of randomized controlled trials. J Am Med Dir Assoc. 2018 May;19(5):384-90.[Abstract]
89. Shane E, Burr D, Abrahamsen B, 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 Jan;29(1):1-23.[Abstract][Full Text]
90. Abrahamsen B. Adverse effects of bisphosphonates. Calcif Tissue Int. 2010 Jun;86(6):421-35.[Abstract]
91. Lee S, Yin RV, Hirpara H, et al. Increased risk for atypical fractures associated with bisphosphonate use. Fam Pract. 2015 Jun;32(3):276-81.[Abstract][Full Text]
92. Wysowski DK, Chang JT. Alendronate and risedronate: reports of severe bone, joint and muscle pain. Arch Intern Med. 2005 Feb 14;165(3):346-7.[Abstract]
93. Khan AA, Sándor GK, Dore E, et al. Bisphosphonate associated osteonecrosis of the jaw. J Rheumatol. 2009 Mar;36(3):478-90.[Abstract]
94. Woo SB, Hellstein JW, Kalmar JR. Narrative [corrected] review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med. 2006 May 16;144(10):753-61.[Abstract]
95. Black DM, Abrahamsen B, Bouxsein ML, et al. Atypical femur fractures: review of epidemiology, relationship to bisphosphonates, prevention, and clinical management. Endocr Rev. 2019 Apr 1;40(2):333-68.[Abstract][Full Text]
96. Adami S, Felsenberg D, Christiansen C, et al. Efficacy and safety of ibandronate given by intravenous injection once every 3 months. Bone. 2004 May;34(5):881-9.[Abstract]
97. Stakkestad JA, Benevolenskaya LI, Stepan JJ, et al; Ibandronate Intravenous Study Group. Intravenous ibandronate injections given every three months: a new treatment option to prevent bone loss in postmenopausal women. Ann Rheum Dis. 2003 Oct;62(10):969-75.[Abstract][Full Text]
98. Black DM, Reid IR, Boonen S, et al. The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res. 2012 Feb;27(2):243-54.[Abstract][Full Text]
99. Black DM, Reid IR, Cauley JA, et al. The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res. 2015 May;30(5):934-44.[Abstract][Full Text]
100. Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007 May 3;356(18):1809-22.[Abstract][Full Text]
101. Nancollas GH, Tang R, Phipps RJ, et al. Novel insights into actions of bisphosphonates on bone: differences in interactions with hydroxyapatite. Bone. 2006 May;38(5):617-27.[Abstract]
102. MacLean C, Newberry S, Maglione M, et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008 Feb 5;148(3):197-213.[Abstract][Full Text]
103. Sharma A, Einstein AJ, Vallakati A, et al. Risk of atrial fibrillation with use of oral and intravenous bisphosphonates. Am J Cardiol. 2014 Jun 1;113(11):1815-21.[Abstract]
104. Pazianas M, Compston J, Huang CL. Atrial fibrillation and bisphosphonate therapy. J Bone Miner Res. 2010 Jan;25(1):2-10.[Abstract][Full Text]
105. US Food and Drug Administration. FDA investigating risk of severe hypocalcemia in patients on dialysis receiving osteoporosis medicine Prolia (denosumab). Nov 2022 [internet publication].[Full Text]
106. Cummings SR, San Martin J, McClung MR, et al; FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009 Aug 20;361(8):756-65.[Abstract][Full Text]
107. Papapoulos S, Lippuner K, Roux C, et al. The effect of 8 or 5 years of denosumab treatment in postmenopausal women with osteoporosis: results from the FREEDOM Extension study. Osteoporos Int. 2015 Dec;26(12):2773-83.[Abstract][Full Text]
108. Bone HG, Wagman RB, Brandi ML, et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol. 2017 Jul;5(7):513-23.[Abstract]
109. Cummings SR, Ferrari S, Eastell R, et al. Vertebral fractures after discontinuation of denosumab: a post hoc analysis of the randomized placebo-controlled FREEDOM trial and its extension. J Bone Miner Res. 2018 Feb;33(2):190-8.[Abstract][Full Text]
110. Horne AM, Mihov B, Reid IR. Bone loss after romosozumab/denosumab: effects of bisphosphonates. Calcif Tissue Int. 2018 Jul;103(1):55-61.[Abstract]
111. Leder BZ, Tsai JN, Uihlein AV, et al. Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): extension of a randomised controlled trial. Lancet. 2015 Sep 19;386(9999):1147-55.[Abstract][Full Text]
112. Zhang C, Song C. Combination therapy of PTH and antiresorptive drugs on osteoporosis: a review of treatment alternatives. Front Pharmacol. 2020 Jan 27;11:607017.[Abstract][Full Text]
113. Zhu Y, Huang Z, Wang Y, et al. The efficacy and safety of denosumab in postmenopausal women with osteoporosis previously treated with bisphosphonates: a review. J Orthop Translat. 2020 May;22:7-13.[Abstract][Full Text]
114. Lyu H, Jundi B, Xu C, et al. Comparison of denosumab and bisphosphonates in patients with osteoporosis: a meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2019 May 1;104(5):1753-65.[Abstract][Full Text]
115. Li W, Ning Z, Yang Z, et al. Safety of denosumab versus zoledronic acid in the older adults with osteoporosis: a meta-analysis of cohort studies. Arch Osteoporos. 2022 Jun 17;17(1):84.[Abstract]
116. Diker-Cohen T, Rosenberg D, Avni T, et al. Risk for infections during treatment with denosumab for osteoporosis: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2020 May 1;105(5):dgz322.[Abstract][Full Text]
117. Catton B, Surangiwala S, Towheed T. Is denosumab associated with an increased risk for infection in patients with low bone mineral density? A systematic review and meta-analysis of randomized controlled trials. Int J Rheum Dis. 2021 Jul;24(7):869-79.[Abstract]
118. Lv F, Cai X, Yang W, et al. Denosumab or romosozumab therapy and risk of cardiovascular events in patients with primary osteoporosis: systematic review and meta-analysis. Bone. 2020 Jan;130:115121.[Abstract]
119. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001 May 10;344(19):1434-41.[Abstract][Full Text]
120. Yang C, Le G, Lu C, et al. Effects of teriparatide compared with risedronate in the treatment of osteoporosis: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2020 Feb;99(7):e19042.[Abstract][Full Text]
121. Shen J, Ke Z, Dong S, et al. Pharmacological therapies for osteoporosis: a Bayesian network meta-analysis. Med Sci Monit. 2022 Apr 17;28:e935491.[Abstract][Full Text]
122. Tian A, Jia H, Zhu S, et al. Romosozumab versus teriparatide for the treatment of postmenopausal osteoporosis: a systematic review and meta-analysis through a grade analysis of evidence. Orthop Surg. 2021 Oct;13(7):1941-50.[Abstract][Full Text]
123. Poutoglidou F, Samoladas E, Raikos N, et al. Efficacy and safety of anti-sclerostin antibodies in the treatment of osteoporosis: a meta-analysis and systematic review. J Clin Densitom. 2022 Jul-Sep;25(3):401-15.[Abstract]
124. Miller PD, Hattersley G, Riis BJ, et al. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial. JAMA. 2016 Aug 16;316(7):722-33.[Abstract]
125. Cosman F, Miller PD, Williams GC, et al. Eighteen months of treatment with subcutaneous abaloparatide followed by 6 months of treatment with alendronate in postmenopausal women with osteoporosis: results of the ACTIVExtend trial. Mayo Clin Proc. 2017 Feb;92(2):200-10.[Abstract][Full Text]
126. Bone HG, Cosman F, Miller PD, et al. ACTIVExtend: 24 months of alendronate after 18 months of abaloparatide or placebo for postmenopausal osteoporosis. J Clin Endocrinol Metab. 2018 Aug 1;103(8):2949-57.[Abstract][Full Text]
127. Miller PD, Bilezikian JP, Fitzpatrick LA, et al. Abaloparatide: an anabolic treatment to reduce fracture risk in postmenopausal women with osteoporosis. Curr Med Res Opin. 2020 Nov;36(11):1861-72.[Abstract][Full Text]
128. Reginster J-Y, Bianic F, Campbell R, et al. Abaloparatide for risk reduction of nonvertebral and vertebral fractures in postmenopausal women with osteoporosis: a network meta-analysis. Osteoporos Int. 2019 Jul;30(7):1465-73.[Abstract][Full Text]
129. Black DM, Schwartz AV, Ensrud KE, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006 Dec 27;296(24):2927-38.[Abstract][Full Text]
130. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999 Aug 18;282(7):637-45.[Abstract][Full Text]
131. Ma HY, Chen S, Lu LL, et al. Raloxifene in the treatment of osteoporosis in postmenopausal women with end-stage renal disease: a systematic review and meta-analysis. Horm Metab Res. 2021 Nov;53(11):730-7.[Abstract][Full Text]
132. Pinkerton JV, Thomas S, Dalkin AC. Osteoporosis treatment and prevention for postmenopausal women: current and future therapeutic options. Clin Obstet Gynecol. 2013 Dec;56(4):711-21.[Abstract]
133. Santen RJ, Allred DC, Ardoin SP, et al. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2010 Jul;95(7 suppl 1):s1-66.[Abstract][Full Text]
134. Medicines and Healthcare products Regulatory Agency. Hormone replacement therapy (HRT): further information on the known increased risk of breast cancer with HRT and its persistence after stopping. Aug 2019 [internet publication].[Full Text]
135. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019 Sep 28;394(10204):1159-68.[Abstract][Full Text]
136. Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004 Apr 14;291(14):1701-12.[Abstract]
137. Sjögren LL, Mørch LS, Løkkegaard E. Hormone replacement therapy and the risk of endometrial cancer: a systematic review. Maturitas. 2016 Sep;91:25-35.[Abstract]
138. Muñoz-Torres M, Alonso G, Raya MP. Calcitonin therapy in osteoporosis. Treat Endocrinol. 2004;3(2):117-32.[Abstract]
139. Chesnut CH 3rd, Silverman S, Andriano K, et al; PROOF Study Group. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence of Osteoporotic Fractures study. Am J Med. 2000 Sep;109(4):267-76.[Abstract]
140. European Medicines Agency. European Medicines Agency recommends limiting long-term use of calcitonin medicines. Jul 2012 [internet publication].[Full Text]
141. US Food and Drug Administration. Questions and answers: changes to the indicated population for Miacalcin (calcitonin-salmon). Sep 2015 [internet publication].[Full Text]
142. Shoback D, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society guideline update. J Clin Endocrinol Metab. 2020 Mar 1;105(3):dgaa048.[Abstract][Full Text]
143. Cosman F, Crittenden DB, Adachi JD, et al. Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med. 2016 Oct 20;375(16):1532-43.[Abstract][Full Text]
144. Saag KG, Petersen J, Brandi ML, et al. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017 Oct 12;377(15):1417-27.[Abstract][Full Text]
145. Liu Y, Cao Y, Zhang S, et al. Romosozumab treatment in postmenopausal women with osteoporosis: a meta-analysis of randomized controlled trials. Climacteric. 2018 Apr;21(2):189-95.[Abstract]
146. Prather C, Adams E, Zentgraf W. Romosozumab: a first-in-class sclerostin inhibitor for osteoporosis. Am J Health Syst Pharm. 2020 Nov 16;77(23):1949-56.[Abstract]
147. Kaveh S, Hosseinifard H, Ghadimi N, et al. Efficacy and safety of romosozumab in treatment for low bone mineral density: a systematic review and meta-analysis. Clin Rheumatol. 2020 Nov;39(11):3261-76.[Abstract]
148. Nealy KL, Harris KB. Romosozumab: a novel injectable sclerostin inhibitor with anabolic and antiresorptive effects for osteoporosis. Ann Pharmacother. 2021 May;55(5):677-86.[Abstract]
149. Lim SY. Romosozumab for the treatment of osteoporosis in women: efficacy, safety, and cardiovascular risk. Womens Health (Lond). 2022 Jan-Dec;18:17455057221125577.[Abstract][Full Text]
150. Bovijn J, Krebs K, Chen CY, et al. Evaluating the cardiovascular safety of sclerostin inhibition using evidence from meta-analysis of clinical trials and human genetics. Sci Transl Med. 2020 Jun 24;12(549):eaay6570.[Abstract][Full Text]
151. Mariscal G, Nuñez JH, Bhatia S, et al. Safety of romosozumab in osteoporotic men and postmenopausal women: a meta-analysis and systematic review. Monoclon Antib Immunodiagn Immunother. 2020 Apr;39(2):29-36.[Abstract]
152. Boonen S, Reginster JY, Kaufman JM, et al. Fracture risk and zoledronic acid therapy in men with osteoporosis. N Engl J Med. 2012 Nov 1;367(18):1714-23.[Abstract][Full Text]
153. Junjie W, Dongsheng H, Lei S, et al. Testosterone replacement therapy has limited effect on increasing bone mass density in older men: a meta-analysis. Curr Pharm Des. 2019;25(1):73-84.[Abstract]
154. Committee on Assessing the Need for Clinical Trials of Testosterone Replacement Therapy. 2004 executive summary. In: Liverman CT, Blazer DJ, eds. Testosterone and aging: clinical research directions. Washington, DC: The National Academic Press; 1-10.
155. Khosla S, Amin S, Orwoll E. Osteoporosis in men. Endocr Rev. 2008 Jun;29(4):441-64.[Abstract][Full Text]
156. Orwoll ES, Scheele WH, Paul S, et al. The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis. J Bone Miner Res. 2003 Jan;18(1):9-17.[Abstract][Full Text]
157. Kaufman JM, Orwoll E, Goemaere S, et al. Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int. 2005 May;16(5):510-6.[Abstract]
158. Niimi R, Kono T, Nishihara A, et al. Analysis of daily teriparatide treatment for osteoporosis in men. Osteoporos Int. 2015 Apr;26(4):1303-9.[Abstract]
159. Smith MR, Egerdie B, Hernández Toriz N, et al. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med. 2009 Aug 20;361(8):745-55.[Abstract][Full Text]
160. Lewiecki EM, Blicharski T, Goemaere S, et al. A phase III randomized placebo-controlled trial to evaluate efficacy and safety of romosozumab in men with osteoporosis. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3183-93.[Abstract][Full Text]
161. van Brussel MS, Bultink IE, Lems WF. Prevention of glucocorticoid-induced osteoporosis. Expert Opin Pharmacother. 2009 Apr;10(6):997-1005.[Abstract]
162. Yuan C, Liang Y, Zhu K, et al. Clinical efficacy of denosumab, teriparatide, and oral bisphosphonates in the prevention of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis. J Orthop Surg Res. 2023 Jun 22;18(1):447.[Abstract][Full Text]
163. Brent MB. Abaloparatide: a review of preclinical and clinical studies. Eur J Pharmacol. 2021 Oct 15;909:174409.[Abstract][Full Text]
164. Yamaguchi Y, Morita T, Kumanogoh A. The therapeutic efficacy of denosumab for the loss of bone mineral density in glucocorticoid-induced osteoporosis: a meta-analysis. Rheumatol Adv Pract. 2020;4(1):rkaa008.[Abstract][Full Text]
165. Taylor AD, Saag KG. Anabolics in the management of glucocorticoid-induced osteoporosis: an evidence-based review of long-term safety, efficacy and place in therapy. Core Evid. 2019 Aug 23;14:41-50.[Abstract][Full Text]
166. Popp AW, Isenegger J, Buergi EM, et al. Glucocorticosteroid-induced spinal osteoporosis: scientific update on pathophysiology and treatment. Eur Spine J. 2006 Jul;15(7):1035-49.[Abstract]
167. Czerwinski E, Cardona J, Plebanski R, et al. The efficacy and safety of abaloparatide-SC in men with osteoporosis: a randomized clinical trial. J Bone Miner Res. 2022 Dec;37(12):2435-42.[Abstract][Full Text]
168. American Academy of Orthopedic Surgeons. Acute treatment of hip fractures in older adults. Sep 2023 [internet publication].[Full Text]
169. American Academy of Orthopedic Surgeons. Postoperative rehabilitation of low energy hip fractures in older adults. Sep 2023 [internet publication].[Full Text]
170. Shapiro CL, Van Poznak C, Lacchetti C, et al. Management of osteoporosis in survivors of adult cancers with nonmetastatic disease: ASCO clinical practice guideline. J Clin Oncol. 2019 Nov 1;37(31):2916-46.[Abstract][Full Text]
171. Adler RA, El-Hajj Fuleihan G, Bauer DC, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016 Jan;31(1):16-35.[Abstract][Full Text]
172. Galindo-Zavala R, Bou-Torrent R, Magallares-López B, et al. Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children. Pediatr Rheumatol Online J. 2020 Feb 24;18(1):20.[Abstract][Full Text]
173. Borgström F, Karlsson L, Ortsäter G, et al. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos. 2020 Apr 19;15(1):59.[Abstract][Full Text]
174. Sajjan SG, Barrett-Connor E, McHorney CA, et al. Rib fracture as a predictor of future fractures in young and older postmenopausal women: National Osteoporosis Risk Assessment (NORA). Osteoporos Int. 2012 Mar;23(3):821-8.[Abstract][Full Text]
175. Ye J, Li Q, Nie J. Prevalence, characteristics, and associated risk factors of wrist fractures in Americans above 50: the cross-sectional NHANES study. Front Endocrinol (Lausanne). 2022 Apr 25;13:800129.[Abstract][Full Text]
176. Barrett-Connor E, Sajjan SG, Siris ES, et al. Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int. 2008 May;19(5):607-13.[Abstract]
177. D'Amelio P, Isaia GC. The use of raloxifene in osteoporosis treatment. Expert Opin Pharmacother. 2013 May;14(7):949-56.[Abstract]
178. Tinetti ME, Baker DI, McAvay G, et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med. 1994 Sep 29;331(13):821-7.[Abstract][Full Text]
179. Santesso N, Carrasco-Labra A, Brignardello-Petersen R. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev. 2014 Mar 31;(3):CD001255.[Abstract][Full Text]