Table 2 Societal Recommendations for the Management of Osteoporosis

Monitoring response to treatment with DXA scanning

• Every 1–2 years

• Every 2 years

• Every 1–3 years

• Recommends against checking during the 5 years of pharmacologic therapy

Use of bone turnover markers

• Consider use to assess compliance and efficacy of treatment

• No recommendations

• Recognizes it as an alternative way of identifying therapy response

• No recommendations

Treatment choice

• Alendronate, risedronate, zoledronic acid, or denosumab for high risk patients

• Teriparatide, denosumab, or zoledronic acid for high risk patients unable to tolerate oral therapy

• Raloxifene or ibandronate for patients requiring spine-specific therapy

• No specific recommendations

• Alendronate, risedronate, zoledronic acid, ibandronate, or denosumab for high risk patients

• Teriparatide or abaloparatide for very high risk patients

• Alendronate, risedronate, zoledronic acid, or denosumab treatment for 5 years.

• Recommends against estrogen or raloxifene therapy