➤ Recommendation 3.5. Provided T-score and/or risk assessment (e.g.,
FRAX-estimated fracture risk) exceed threshold values for fractures
(as described in 3.4), the following specific populations may be
considered appropriate candidate for bone modifying agents (Strong
Recommendation; EB-B-H):
• Premenopausal women receiving GnRH therapies causing ovarian suppression or with
CIOF or who have had an oophorectomy
• Postmenopausal women who are receiving aromatase inhibitors
• Men who have received or are receiving androgen deprivation therapy
• Patients undergoing or with a history of bone marrow transplant
• Patients with chronic (>3–6 months) glucocorticoid use
Qualifying statement. The short-term bone loss associated with these conditions can be very
rapid. Because of this, clinicians could consider treatment at higher bone density or T-score
than recommended using FRAX or similar tools, with decision-making further guided by
anticipated losses as reviewed in the text (i.e., the bulleted conditions above should be included
as having "secondary osteoporosis" in the FRAX assessment tool).
