Start

Evaluate for secondary causes

Observe and recommend

Calcium
Vitamin D
Exercise
Repeat BMD in 2-5 yr

^* Patients with fragility fractures and a T-score above –1.0 should be evaluated for other causes of pathologic fracture.

End

Recommend

Calcium, vitamin D, exercise
plus
Antiresorptive therapy

Low risk

High risk

Bone densitometry

T-score
Above –1.0^*

T-score
–1.0 to –2.5

T-score
Below –2.5

Recommend

Calcium, vitamin D, exercise
plus
Antiresorptive therapy

Treat secondary causes

Postmenopausal women >65 yr

All patients with fragility fractures

Postmenopausal women <65 yr with risk factors

Men with risk factors (e.g., chronic corticosteroid use)