Osteoporosis
Also known as: fragility fracture · low bone density · osteopenia
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Clinician's Guide to Prevention and Treatment of Osteoporosis
Bone Health & Osteoporosis Foundation (BHOF) · 2022
BHOF's clinician guide gives concise recommendations on preventing, assessing, diagnosing and treating osteoporosis in postmenopausal women and men aged 50 and older.
European Guidance for the Diagnosis and Management of Osteoporosis in Postmenopausal Women
ESCEO and IOF · 2019
This ESCEO/IOF guidance describes fracture risk assessment, diagnostic criteria and treatment pathways for postmenopausal osteoporosis in a European setting.
- It was issued by the ESCEO Scientific Advisory Board with the IOF Committees of Scientific Advisors and National Societies and published in Osteoporosis International. source
- The document updates the previous European guidance from 2013 and includes management algorithms stratified by fracture risk. source
US vs EU key differences
- Population scope differs: the European guidance is written specifically for postmenopausal women, while the US guide also covers men, recommending bone density screening for all women 65 and older and all men 70 and older, plus those aged 50–69 with clinical risk factors. source
- Treatment thresholds are built differently: US practice applies fixed FRAX cutoffs of a 10-year hip fracture probability of at least 3% or major osteoporotic fracture probability of at least 20%, whereas the European guidance uses age-dependent intervention thresholds that rise with age up to about 70 before becoming fixed. source
- The European approach defines very high fracture risk relative to the intervention threshold — exceeding it by roughly 60% — to select candidates for bone-forming agents, rather than by a single absolute probability number. source
- The European guidance is explicitly a platform on which national guidelines are built for Europe's varied health systems, rather than a single prescriptive standard like the US clinician's guide. source
What changed recently
- US2014 → 20222022-06-01
The 2022 edition replaced the 2014 NOF Clinician's Guide and introduced a distinct 'very high fracture risk' category, for which osteoanabolic agents such as teriparatide, abaloparatide or romosozumab are recommended as initial therapy rather than being reserved for bisphosphonate failure. It also added explicit guidance on treatment sequencing and on following an anabolic course with an antiresorptive to preserve gains.
source ↗curation confidence 90% - EU2013 → 20192019-01-01
The 2019 ESCEO/IOF guidance updated the 2013 European guidance by replacing a two-tier risk split with a three-tier FRAX-based stratification into low, high and very high fracture risk, with decision algorithms that direct very-high-risk women toward more potent or parenteral therapy up front. It also set explicit calcium (800-1200 mg/day) and cholecalciferol (800-1000 IU/day) intake targets for women at increased fracture risk.
source ↗curation confidence 90%
See the full update feed for changes across every system.