After covering an introduction to fragility fractures
and nonpharmacologic treatment options
, we will cover pharmacologic management options for when the provider deems this to be appropriate. Treatment is usually initiated after any hip or vertebral fractures, T-score of less than 2.5 at the femoral neck, total hip or lumbar spine by DXA scan, post-menopausal women or men age 50 or older with osteopenia (T-score -1.0 and -2.5) at the femoral neck, total hip or lumbar spine by DZA and a 10 year hip fracture probability of greater than 3% or a 10 year major osteoporosis-related fracture probability of greater than 20% based on FRAX score (1). The goal with treatment aims to increase bone mass and strength by inhibiting bone resorption or promoting bone formation. Management and choice of agent is dependent on many factors and each case should be individualized depending on past medical history and toleration of agents.