Common Questions
Click on a category to see a list of common questions.
- General Questions
- Top Questions
- Epidemiology
- Bone Density Measurement
- Male Osteoporosis
- Drug Therapy
- General
- Bisphosphonates
- Calcitonin
- Estrogen
- SERMs
- Teriparitide
- Thiazides
- Prevention
- Calcium and Vitamin D
- Falls and Exercise
- Risk Assessment
- Screening Issues
- Secondary Osteoporosis
- Depot Medroxyprogesterone
- Eating Disorders
- Medication
- Vitamin D Deficiency
Top Questions
- What is the average annual rate of bone density loss in women?
- What is the appropriate screening interval for osteoporosis?
- Is there any indication to start medication in an individual who has osteopenia as defined by a BMD T score that is higher than -2.5 but less than -1.0?
- What risk factors (not including secondary causes) would prompt you to screen for osteoporosis in a postmenopausal woman younger than 65?
- Can the total hip BMD rather than the femoral neck BMD be used in the FRAX algorithm?
- How do you answer some of the FRAX clinical risk factor questions (ex. smoking) if you are unsure of the duration or amount?
- What absolute 10-year risk of a hip fracture or a major osteoporotic fracture should you consider osteoporosis treatment?
- Does the cost-effective intervention threshold for osteoporosis treatment differ between races?
- How can you estimate the 10 year risk of a major osteoporotic fracture in a male?
- What is a fragility fracture?
- What are the indications to obtain lateral thoracic spine X-rays?
Epidemiology
- What is the average annual rate of bone density loss in women?
- Which ethnic groups are at increased risk for osteoporosis or fractures?
Bone Density Measurement
- How often should I repeat DXA?
- What is the most accurate/precise method of measuring bone density? What are other central bone mass measurement methods?
- What are the available types of peripheral bone density measurements and how do they compare?
- How is bone density quantified?
- What is a T-score? What is a Z-score?
- What bone density measurement site correlates best with clinically important fractures?
- How do DXA scanner results compare among different manufacturers?
- What are Medicare bone density reimbursement guidelines?
- How do I follow changes in bone mineral density?
- How precise are repeat measures with DXA?
- How do I interpret a DXA report?
- What is the role of broadband ultrasound in the evaluation of osteoporosis?
Male Osteoporosis
- What are important risk factors for osteoporosis or hip fracture in men?
- What is the prevalence and incidence of osteoporosis in older men as compared to postmenopausal white women?
- Is routine screening for osteoporosis recommended for men?
- What tests are used in diagnosing male hypogonadism?
- Why measure bone mineral density in at-risk men as well as women?
- What is the appropriate work-up of osteoporosis in men?
- What are treatment options for osteoporosis in men?
- What are some options for testosterone replacement therapy?
- What is the effect of testosterone replacement on bone density in hypogonadal men?
- How can you estimate the 10 year risk of a major osteoporotic fracture in a male?
Drug Therapy: General
Drug Therapy: Bisphosphonates
- How should I advise patients to take oral bisphosphonates?
- What is the number needed to treat (NNT) with alendronate to prevent one clinical osteoporotic fracture?
- What is the danger of esophageal erosions with bisphosphonates?
- What is the role of bisphosphonates in treatment of anorexia nervosa-associated bone loss?
- What is the evidence that bisphosphonates can prevent fractures in osteopenic women without prior fracture?
- What are the dosing forms of bisphosphonates?
- What is the evidence that bisphosphonates prevent fractures in postmenopausal women with osteoporosis?
- What are potential side effects of bisphosphonates?
- What are long-term safety concerns regarding use of bisphosphonates?
Calcitonin
- Drug Mini-Monograph: Calcitonin in the prevention and treatment of osteoporosis
- Is calcitonin helpful in reducing bone pain in osteoporotic fractures?
- In what form is calcitonin most commonly used?
- Is calcitonin a second line treatment option for osteoporosis?
- Does calcitonin reduce the risk of fractures?
Drug Therapy: Estrogen
- Drug Mini-Monograph: Estrogens in the prevention of osteoporosis
- What did the Women's Health Initiative (WHI) reveal about the risks of menopausal hormone therapy (HT)?
- How do you discontinue HT and is there any evidence that lower doses of estrogen can increase bone mass or reduce fracture rate?
- What is the effect of discontinuation of hormone therapy (HT) on bone density?
- What is the current role for HT in postmenopausal women in the prevention and treatment of osteoporosis?
- Does prior use of estrogen increase bone mineral density long term?
- What is the role of estrogen in bone health?
- What is the role of exogenous estrogen in treatment of anorexia nervosa-associated bone loss?
- What were the fracture outcomes in the WHI study?
Drug Therapy: SERMs
- Drug Mini-Monograph: Selective estrogen receptor modulators (SERMs) in the prevention and treatment of osteoporosis
- What is the evidence that raloxifene prevents fractures in postmenopausal women with osteoporosis?
- What are the adverse side effects of selective estrogen receptor modulators?
- How effective is raloxifene in reducing the risk of fractures in postmenopausal women with osteoporosis?
- How does raloxifene affect the risk of invasive breast cancer?
- What drugs may interact with raloxifene?
- How does raloxifene affect lipids and coronary heart disease (CHD)?
Teriparitide
- Who is a good candidate for teriparatide?
- How does teriparatide affect bones?
- Does teriparatide reduce the risk of fractures?
- Is the combination of a bisphosphonate and teriparatide more effective in increasing BMD or decreasing fracture rates than with teriparatide alone?
- What are the potential side effects of teriparatide?
- What are contraindications to using teriparatide?
- What is the maximum duration of use of teriparatide as recommended by the FDA?
Thiazides
- Which antihypertensive agents have been shown in randomized controlled trials to increase bone mineral density (BMD)?
- What is the mechanism by which thiazide diuretics affect bone mineral density?
- How does hydrochlorothiazide affect fracture risk?
- What are the potential adverse reactions/side effects of HCTZ?
- Is HCTZ FDA-approved for treatment of osteoporosis or osteopenia?
Prevention: Calcium & Vitamin D
Prevention: Falls and Exercise
- What is the role of falls in osteoporosis fracture incidence?
- Do hip protectors prevent fractures?
- What interventions prevent falls?
- What are some risk factors for serious falls?
- How can you screen a patient for unsteadiness on physical exam?
- What is the strength of evidence supporting a relationship between osteoporosis and exercise?
- Is physical inactivity a clinical risk factor for osteoporosis-related fractures?
- Does the initiation of exercise in sedentary, premenopausal women reduce their future risk of osteoporosis and fracture?
- What are the standards of exercise recommended for osteoporosis prevention and overall health and fitness?
- Can the initiation of exercise in young girls help prevent osteoporosis?
- Does the initiation of exercise in sedentary, postmenopausal women with osteopenia reduce their future risk of osteoporosis and fracture?
Screening Issues
- What are screening recommendations of the U.S. Preventive Services Task Force?
- Who should be evaluated for secondary causes of osteoporosis?
- What is an appropriate diagnostic work-up for secondary osteoporosis?
- Is routine screening for osteoporosis recommended for all women?
- Are peripheral DXA results useful for diagnosing osteoporosis?
- What is the appropriate screening interval for osteoporosis?
- Is screening for osteoporosis recommended in elderly men without risk factors?
- Is there any indication to start medication in an individual who has osteopenia as defined by a BMD T score that is higher than -2.5 but less than -1.0?
- What risk factors (not including secondary causes) would prompt you to screen for osteoporosis in a postmenopausal woman younger than 65?
- Can the total hip BMD rather than the femoral neck BMD be used in the FRAX algorithm?
- How do you answer some of the FRAX clinical risk factor questions (ex. smoking) if you are unsure of the duration or amount?
- What absolute 10-year risk of a hip fracture or a major osteoporotic fracture should you consider osteoporosis treatment?
- Does the cost-effective intervention threshold for osteoporosis treatment differ between races?
Secondary Osteoporosis: Depot Medroxyprogesterone
- How does current DMPA use affect bone mineral density (BMD) in adolescents?
- How does current use of DMPA affect fracture risk in adolescents?
- How does depot medroxyprogesterone (DMPA) cause bone loss?
- Do other progestogen-only forms of birth control cause a decrease in BMD similar to DMPA?
- Does the addition of estrogen help to minimize bone loss in adolescent DMPA users?
- What lifestyle measures can be taken to prevent bone loss in adolescents?
- What happens to bone mineral density when DMPA is discontinued?
- When is it recommended to obtain a DEXA study on an adolescent or woman using DMPA?
- What are the advantages of DMPA use in adolescents?
Secondary Osteoporosis: Eating Disorders
- What is the relationship between eating disorders and osteoporosis?
- What are the mechanisms of bone loss in anorexia nervosa?
- What is the athletic triad?
- What is the mechanism of amenorrhea in anorexia nervosa?
- What treatment is effective in reversing bone loss in anorexia nervosa?
- What is the role of calcium and vitamin D in treatment of anorexia nervosa-associated bone loss?
Secondary Osteoporosis: Medication
- What medications are associated with an increased risk of osteoporosis?
- How does corticosteroid dose affect the risk of osteoporosis?
- What is appropriate monitoring and treatment of patients on systemic corticosteroids?
- What medicines should be used to treat corticosteroid-induced osteoporosis?
- What are detailed prevention guidelines and rationale for corticosteroid induced osteoporosis?
- What is the role of thiazide diuretics, beta blockers, and statins, in prevention of steroid-induced bone loss?
- How do rheumatoid arthritis and other inflammatory diseases affect bone density?
- What is the mechanism by which corticosteriods cause osteoporosis?
Secondary Osteoporosis: Vitamin D Deficiency
- How do osteoporosis and osteomalacia differ?
- What causes vitamin D deficiency?
- What factors influence skin synthesis of vitamin D?
- What are the dietary sources of vitamin D?
- How is vitamin D deficiency determined?
- What laboratory abnormalities are found in vitamin D deficiency?
- How is vitamin D deficiency treated and monitored?