Moderate risk includes no prior hip or spine fractures, a BMD T-score at the hip and spine both
above -2.5, or 10-year hip fracture risk <3% or risk of major osteoporotic fractures <20%.
High risk includes a prior spine or hip fracture, or a BMD T-score at the hip or spine equal to or
below -2.5, or 10-year hip fracture risk ≥3%, or risk of major osteoporotic fracture risk ≥20%.
Very high risk includes multiple spine fractures and a BMD T-score at the hip or spine equal to or below -2.5.
Postmenopausal Women
optimization for bone health especially
and vitamin D
according to country-specific guidelines
(4.1) Teriparatide or
Abaloparatide for 2 yrs
(8.1) Calcium + Vitamin
D as adjunct therapy
(A.1) Romosozumab
For 1 yr
(8.1) Calcium + Vitamin D
as adjunct therapy
Low-Moderate Risk
Consider giving
bisphosphonates and then
stopping for a drug holiday
(9.1) Reassess fracture risk
every 1-3 years
lf bone loss, fracture occurs
or patient becomes high
risk, consider restarting
therapy
High Risk
(3.2) Continue
therapy or switch to
another therapy
Consider (in order):
1) SERM (5.1)
2) HT Tibolone (6.1+ 6.2)
3) Calcitonin (7.1)
4) Calcium + Vitamin D (8.2)
(A.2)
