NOF Clinician's Guide to Prevention and Treatment of Osteoporosis

The Clinician's Guide to Prevention and Treatment of Osteoporosis is intended to inform clinical decision making for the management of men and women at high fracture risk. It integrates the expression of a patient's fracture risk as a 10-year probability (the output from FRAX^®) with current clinical recommendations for the management of osteoporosis.

According to the Clinician's Guide, healthcare providers should consider FDA-approved medical therapies in postmenopausal women and men aged 50 years and older, based on the following:

• A hip or vertebral (clinical or morphometric) fracture
• T-score ≤ -2.5 at the femoral neck or spine after appropriate evaluation to exclude secondary causes
• Low bone mass (T-score between -1.0 and -2.5 at the femoral neck or spine) AND a 10-year probability of a hip fracture ≥ 3% OR a 10-year probability of a major osteoporosis-related fracture ≥ 20% based on the US-adapted WHO algorithm
• Clinician's judgment and/or patient preferences may indicate treatment for people with 10-year fracture probabilities above or below these levels

The printed version of the Clinician's Guide was published in 2008. NOF will periodically make revisions to the online version. Visit our website regularly to see if an updated online version of the Clinician's Guide is available.

A single print copy of the 2008 Clinician's Guide is available at no charge. A pack of 10 copies is available for $15. To request a free print copy or to purchase quantities, please complete the order form. You can also purchase quantities of the 2008 print version from NOF's online store.

January 2010 online updates to the 2008 Clinician's Guide include revisions to the following:

Chapter 3: Diagnosis and Management

• Biochemical markers (page 14)
• Use of WHO Fracture Risk Algorithm (FRAX^®) in the US (pages 14-15)

Chapter 5: Pharmacologic Therapy

• Updated FDA indications for zoledronic acid (page 22)
• Updated FDA indication for parathyroid hormone (page 24)

Download the Clinician's Guide to Prevention and Treatment of Osteoporosis

• The Clinician's Guide to Prevention and Treatment of Osteoporosis (2010)
• The Clinician's Guide to Prevention and Treatment of Osteoporosis (2008)

Access FRAX^® - WHO Fracture Risk Assessment Tool

• Calculate a FRAX^® Score
• Learn about updates to the FRAX^® tool 

Related and Supporting Documents (2010)

• Overview of the Clinician's Guide
• NOF/ISCD FRAX^® Implementation Guide
• The effects of a FRAX^® revision for the USA (2010)
• The potential impact of new National Osteoporosis Foundation guidance on treatment patterns (2010)
• Updated fracture incidence rates for the US version of FRAX^® (2010)

Related and Supporting Documents (2008)

• Cost-effective osteoporosis treatment thresholds: the United States perspective (2008)
• Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA (2008)
• Assessment of 10-year absolute fracture risk: a new paradigm with worldwide application (2008)
• WHO Scientific Group on the Assessment of Osteoporosis at the Primary Health Care Level
• WHO Scientific Report Annexes