Mount Carmel Health Partners Clinical Guidelines Osteoporosis

Osteoporosis Clinical Guideline
Definition: Osteoporosis is a multifactorial skeletal disease characterized by low bone mineral density with micro-architectural disruption and
skeletal fragility resulting in decreased bone strength and an increased risk of fracture.
Causes: Osteoporosis is the result of an inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and/or lack of estrogen. It
is also associated with hormonal disorders like hyperparathyroidism or chronic diseases that interfere with mobility. Certain medications, such as
glucocorticoids, can also induce osteoporosis.
Quick Guide to
Osteoporosis Care
• Diagnosis should be made
by a bone minerals density
(BMD) test.
• Patients should be tested
and treated for secondary
causes of osteoporosis
(see Table C).
• Treatment includes
lifestyle modification and
bisphosphonates as
first-line medication.
• If the patient has a fragile
fracture, osteoporosis
treatment is indicated
even if the BMD test
results are normal.
• Treatment should also
continue even if follow-up
BMD test results are
normal after 1 to 2 years
of treatment.
Evaluation
Treatment
Has patient had a
vertebral, hip/femur,
or other fragility
fracture?
No
Is the patient a
woman aged 65 or
over?
Does the patient
have risk factors for
osteoporosis?
(see Table D)
No
No
Yes
Yes
Yes
Obtain a BMD
measurement if
more than 2 years
since last done
Is the patient
currently on
medication to treat
osteoporosis?
Yes
No
Obtain a BMD
measurement if
more than 2 years
since last done
Obtain additional labs:
• Biochemistry profile
• 25-hydroxyvitamin D
• Complete blood count
• TSH
Were the lab
results
normal?
Yes
Yes
Was the BMD
measurement below
normal?
(see Table B)
No
Encourage lifestyle modifications.
Prescribe appropriate medications.
(See Treatment Recommendations, Page 2)
No
Treat secondary causes
(see Table C)
Continue yearly assessment of
medications and lifestyle modifications.
Obtain a follow-up BMD measurement
after 1 to 2 years of treatments.
Continue to assess the
patient yearly for risk factors.
July 2017