Osteoporosis and osteopenia
Case finding with FRAX and DXA, the RACGP/Healthy Bones Australia 2024 treatment thresholds, secondary causes, bisphosphonates, denosumab and why it can't just stop, anabolic-first therapy for very high risk, PBS criteria including the 2026 abaloparatide listing, and drug holidays.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Osteoporosis is low bone mass and poor microarchitecture causing fragility fractures. Over half of Australians over 50 have osteoporosis or osteopenia. One in three women and one in five men over 50 will have a fracture.
- A minimal-trauma fracture (a fall from standing height or less) after 50 means osteoporosis until proven otherwise, whatever the BMD. It's the strongest predictor of the next fracture, and that risk is highest in the first 24 months.
- Australia uses case finding, not screening: FRAX for those with risk factors, then DXA if indicated (RACGP/Healthy Bones Australia 2024).
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Sources
- Osteoporosis management and fracture prevention in postmenopausal women and men over 50 years of age, 3rd editionAU/NZRACGP and Healthy Bones Australia, 2024
- 2024 RACGP and Healthy Bones Australia guideline for osteoporosis management and fracture prevention (summary)AU/NZMed J Aust 2025;222(9), 2025
- Endocrinology (Therapeutic Guidelines)AU/NZTherapeutic Guidelines Ltd
- New treatment announced on PBS (abaloparatide)AU/NZHealthy Bones Australia, August 2026
- Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guidelineEastell et al., J Clin Endocrinol Metab 2019;104:1595-622, 2019
- Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society guideline update (romosozumab)Shoback et al., J Clin Endocrinol Metab 2020;105:587-94, 2020
- The clinician's guide to prevention and treatment of osteoporosisLeBoff et al. (Bone Health and Osteoporosis Foundation), Osteoporos Int 2022;33:2049-102, 2022
- Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis (HORIZON Pivotal Fracture Trial)Black et al., N Engl J Med 2007;356:1809-22, 2007
- Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral ResearchAdler et al., J Bone Miner Res 2016;31:16-35, 2016
- Zoledronic acid and clinical fractures and mortality after hip fracture (HORIZON Recurrent Fracture Trial)Lyles et al., N Engl J Med 2007;357:1799-809, 2007
- Denosumab for prevention of fractures in postmenopausal women with osteoporosis (FREEDOM)Cummings et al., N Engl J Med 2009;361:756-65, 2009
- Romosozumab or alendronate for fracture prevention in women with osteoporosis (ARCH)Saag et al., N Engl J Med 2017;377:1417-27, 2017
- Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO)Kendler et al., Lancet 2018;391:230-40, 2018
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy