Treatment Plan

• High risk + BMD ≤ -2.5: Start bone-sparing medication (bisphosphonates)
• High risk + BMD > -2.5: Treat modifiable risk factors, repeat DEXA in 2 years
• Intermediate risk: Offer DEXA if close to 10% & has certain underestimated risk factors (regular Corticosteroid use, history of multiple fragility fractures, smoking & alcohol)
• Remaining Intermediate/low risk: Lifestyle advice, follow-up in 2-5 years

• Medications:

1st line: Alendronic acid or risedronate
2nd line: Zoledronic acid or denosumab

• Calcium/Vitamin D supplementation:

Adequate calcium intake: 400 IU vitamin D daily
Inadequate calcium intake: 1000 IU calcium + 400 IU vitamin D daily
Housebound: 800 IU calcium + 1000 IU vitamin D daily

• Consider HRT for young postmenopausal women.