Evidence-based expert recommendations for the diagnosis and targeted management of osteoporosis

• Author Details:   
• Ram Chaddha
• BL Prakash
• Ravi Sauhta
• Vishal Peshhatiwar
• Dayanidhi Meher
• Alpa Singh ^*
• Monil Gala
• Snehal Muchhala
• Bhavesh Kotak

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To derive practical, experience-driven clinical insights related to evidence-based statements for diagnosing and managing osteoporosis. The meeting involved in-depth discussions and a review of recent literature and real-world clinical perspectives. A set of 32 evidence-based statements was developed following a literature search of English articles from 2018 to 2023, using keywords such as ‘Osteoporosis’, ‘Diagnosis’, ‘Romosozumab’ and ‘anti-osteoporosis’. Two virtual national meetings were held with 23 experts in Orthopaedics, Rheumatology and Endocrinology. According to the evidence-based recommendation, osteoporosis frequently progresses as a "silent disease," showing no signs until a fracture happens. The risk varies by age, gender and other factors. Screening is recommended for postmenopausal women over 50 years and men over 60 years of age due to their higher risk of bone loss. The dual-energy X-ray absorptiometry scan is the gold standard for diagnosing osteoporosis. It should be repeated every 1-2 years to track bone mineral density (BMD). The Fracture Risk Assessment Tool helps to evaluate the risk of fragility fractures. Bone turnover markers help assess the effectiveness of treatment. Anti-osteoporosis treatments are recommended for those at a high or very high fracture risk. Anti-resorptive therapies are suitable for high-risk patients, whereas anabolic therapies are preferred for very high-risk cases. Romosozumab, a dual-action medication, is effective in postmenopausal women and has been approved for men in Japan and Australia as of December 2024. The ideal candidates for Romosozumab include those with declining BMD, despite anti-resorptive treatment or a high fracture risk.

Keywords: Osteoporosis, Postmenopausal, Dual-energy X-ray absorptiometry, Fracture risk assessment tool, Anabolics, Anti-resorptive, Romosozumab, Denosumab.