Diagnosis
The 2020 update of the American Association of Clinical Endocrinologists (AACE) guidelines provides the following criteria for the diagnosis of osteoporosis in postmenopausal women [11] :
T-score −2.5 or below in the lumbar spine, femoral neck, total proximal femur, or 1/3 radius
Low-trauma spine or hip fracture (regardless of BMD)
T-score between −1.0 and −2.5 and a fragility fracture of proximal humerus, pelvis, or distal forearm
T-score between −1.0 and −2.5 and high FRAX️ fracture probability based on country-specific thresholds
The National Osteoporosis Guideline Group (NOGG) recommends considering the following as routine in the investigation of osteoporosis/fragility fractures [246] :
Clinical history
Physical examination including measurement of height and assessment of thoracic kyphosis
Complete blood cell count
Erythrocyte sedimentation rate or C-reactive protein
Serum calcium, albumin, creatinine, phosphate, alkaline phosphatase, and liver transaminases
Serum 25-hydroxyvitamin D
Thyroid function tests
The NOGG recommends that clinicians consider perform the following studies, as indicated [246] :
Serum electrophoresis, immunoglobulins, and free light chain assay
Plasma parathyroid hormone (PTH), if primary hyperparathyroidism suspected
Serum testosterone, sex hormone–binding globulin, follicle-stimulating hormone, luteinizing hormone
24-h urinary free cortisol/overnight dexamethasone suppression test
Serum prolactin
Serum magnesium if hypocalcemic
Tissue transglutaminase antibodies, ± endomysial antibodies (celiac disease screen)
Urinary calcium excretion
Markers of bone turnover (eg, carboxy–terminal collagen crosslinks [CTX], P1NP)
Lateral radiographs of lumbar and thoracic spine or DXA-based lateral vertebral imaging
Bone densitometry (DXA) if indicated by FRAX assessment and/or required for BMD monitoring
Isotope bone scan