‘OsteoporosisPlan

-   Obtain DEXA scan in F > 65 yo, repeat q2-4 years depending on severity
-   Calculate FRAX score for women < 65 yo with risk factors for fracture
-   In newly diagnosed osteoporosis check Vit D, Calcium, Creatinine, and TSH
   - If elevated calcium, consider checking PTH for primary hyperparathyroidism
   - If elevated calcium and normal or low PTH, check PTHrP with concern for breast/lung malignancy
-   Treatment should be initiated if T score < -2.5, T score between -1 and -2.5 & 10 year probability of hip fracture of at least 3%, or any major fracture of at least 20% as calculated by FRAX
-   Nonpharmacologic Treatment
   - Smoking Cessation
   - Alcohol Moderation (≤ 4 drinks/d for M or ≤ 2 drinks/d for F)
   - Exercise with Strength/Balance Training
   - Vitamin D 800 IU/day
   - Sunlight Exposure 30 min/day, 5 days per week
-   Pharmacologic Treatment
   - Bisphosphonates, limit to 5 years of use
                   - Prolonged use may increase risk of osteonecrosis of jaw and atypical femoral fracture
   - Denosumab (Prolia)
                   - Injection q6mo for 3 years