MDCalc is a 13-year-old medical reference started by two practicing emergency medicine physicians, Dr. Joe Habboushe and Dr. Graham Walker. These factors include: BMI (weight to height ratio calculation) Have you ever had a bone density test on a table machine? A unit of alcohol varies slightly in different countries from 8-10g of alcohol. Bisphosphonates. Several simplified paper versions, based on the number of risk factors are also available, and can be downloaded for office use. MDCalc. MDCalc loves calculator creators - researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. . A prior clinical vertebral fracture or a hip fracture is an especially strong risk factor. Did you recently attend an American Bone Health event? Can only be used to predict fracture risk in long bones (i.e., not in vertebral mets). If no medical conditions, click next. The probability of fracture computed may therefore be underestimated. The FRAX models were developed from and validated on population-based cohorts from 4 continents; charts are available for many countries.. The other major fractures are your spine, forearm, and shoulder. 1.4 Use either FRAX [ 8] (without a bone mineral density [BMD] value if a dual-energy X-ray absorptiometry [DXA] scan has not previously been undertaken) or QFracture [ 9 . All Rights Reserved. There has been no demonstrated effectiveness of combination therapy in reducing fractures. If you are shorter or taller, enter the minimum or maximum, knowing that the results will be an estimate. International Index of Erectile Function (IIEF-5) Assess erectile dysfunction. Osteoporosis, in which low bone mass and micro-structural deterioration of bone tissue lead to increased bone fragility, is the most common metabolic bone disease in the United States. Your score is then plotted on a graph that suggests whether you should get treatment or make lifestyle changes to manage your risk. The Fracture Risk Assessment Tool (FRAX) (1) is a fracture risk calculator that estimates an individual's 10-year probability of incurring a hip or other major osteoporotic fracture, your FRAX score will be calculated, A risk score of >20 points indicates a very high risk of diabetes (50% chance of diabetes Diabetes medicines also increase fracture risk. [ 1, 2] Osteoporosis can result in devastating physical, psychosocial, and economic consequences. The following is the interpretation of the FRAX score for Canadian users who want to know what weight bearing exercises (to stimulate bone) is appropriate for them from Exercise for Better Bones.. Once you complete the FRAX tool app, you will see several score results as illustrated in the image of the red box above. Let's look at why and your. In patients who cannot tolerate or whose symptoms do not improve with bisphosphonate therapy, teriparatide (Forteo) and denosumab (Prolia) are effective alternative medications to prevent osteoporotic fractures. Your FRAX score is your risk of having an osteoporosis-related fracture in the next. Explaining annual updates We release a new version of QRISK every spring, usually in April. Weight must be between 70 and 300 pounds. A diagnosis of osteoporosis isnt a guarantee that youll have a fracture. You are also at an increased risk of falling and fracturing because of blood sugar levels, declining vision, associated peripheral neuropathy and nerve damage. The Fracture Risk Assessment Tool, or FRAX, is a free online tool that estimates your risk of having a hip or other major fracture in the next 10 years, especially if you have osteoporosis. Enter "No" if you have never smoked or have quit. Enter yes if the patient takes 3 or more units of alcohol daily. Follow this link for information on the tool:http://www.garvan.org.au/bone-fracture-risk/, Osteoporosis, New Zealand, This is equivalent to a standard glass of beer (285ml), a single measure of spirits (30ml), a medium-sized glass of wine (120ml), or 1 measure of an aperitif (60ml) (see also notes on risk factors). Reduce bone loss and build stronger muscles. A previous fracture denotes more accurately a previous fracture in adult life occurring spontaneously, or a fracture arising from trauma which, in a healthy individual, would not have resulted in a fracture. Enter yes if the patient is currently exposed to oral glucocorticoids or has been exposed to oral glucocorticoids for more than 3 months at a dose of prednisolone of 5mg daily or more (or equivalent doses of other glucocorticoids) (see also notes on risk factors). The fun challenges, personalized instruction, and motivating rewards help students build their skills and understanding - all while exploring the galaxy with fractions! . A "standard drink" in the USA is 14 g. The FRAX asks for 3 or more units = 24 g, which is slightly less than 2 US drinks/day (28g). Excess alcohol has a negative effect on bone density, fracture, and fracture healing. If left untreated, this can lead to bone diseases like. The calculator was developed using data collected in the Dubbo Osteoporosis Epidemiology Study, conducted by our Bone Biology Theme .The study, begun in 1989, includes data from more than 2,500 men and women aged 60+. Welcome to the QFracture -2016 Web Calculator. Copyright 2015 by the American Academy of Family Physicians. About the bone fracture risk calculator. If you are younger than 45, click here to take the Bone Health Quiz, If you are a Health Care Professional filling this out. FRAX Score: Calculator, Meaning, and More. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. PO Box 688, Wellington 6140, http://www.garvan.org.au/bone-fracture-risk/. For this reason reliance should not be placed on a patient's report of 'arthritis' unless there is clinical or laboratory evidence to support the diagnosis. The QFracture -2016 algorithms have been developed by Julia Hippisley-Cox and Carol Coupland and are based . GlobalRPH has a medcalc for every major clinical specialty including: Cardiology, Critical Care, Dermatology, Endocrinology, Gastroenterology and Hepatology, Geriatrics, Hematology, Infectious Disease, Neurology, Nephrology, Nutrition (TPN, BMR calculators, Fiber), Oncology, Pain Management, Pharmacokinetics, Psychiatry, Rheumatology, Statistics, Cadarette (2004) Osteoporos Int 15(5):361-366 [PubMed] Learn how osteoporosis can affect your spine, and the treatments and exercises that can help you manage symptoms. The WHO criteria should not be applied to men younger than 50 years, children, or premenopausal women. Learn about infusion options for treating osteoporosis and how they compare to other treatment options. The lower your T-score, the lower your bone density. Risk stratify women for likelihood of osteoporosis. Denosumab is a human monoclonal antibody that inhibits the formation and activity of osteoclasts by blocking receptor activator of nuclear factor kappa B ligand. However, osteoarthritis is, if anything, protective. 1. Methods: Fracture risk was calculated using the different screening tools (FRAX, OST, ORAI, OSIRIS and SCORE) for each woman. Weight (kg) 4. Without treatment, osteoporosis can cause dangerous bone breaks and shorten life span. Had multiple osteoporosis-related fractures. Personal details (such as height and weight, medication history, smoking history and family history) are entered to predict whether someone is at risk of developing osteoporosis in the next 10 years. Alcohol 3 or more units/day No Yes 12. In a dose of 60 mg given subcutaneously every six months for three years, it significantly increased BMD in postmenopausal women compared with weekly dosing of alendronate.44 Denosumab has been shown to decrease hip, vertebral, and nonvertebral fractures compared with low doses of calcium and vitamin D. It appears to be a reasonable alternative for persons whose condition does not improve with bisphosphonates. Still, it is often overlooked and undertreated, in large part . The tool was developed to evaluate a patient's 10-year probability of hip fracture and major osteoporotic fracture (clinical spine, forearm, hip, or shoulder fracture). Last medically reviewed on December 8, 2017. Current Smoking No Yes 8. Moderate risk - QRISK2 of 10-20% Calcitonin. The FRAX calculator for the United States is unique in that there exist distinct databases for ethnic minorities. Consuming more than 2.5 units of caffeine daily (1 unit = one cup of coffee or two cups of tea) may increase fracture risk.24 Diets with adequate protein intake are necessary for optimal bone health, but the proper amount or source (plant vs. animal) remains controversial. A decrease in BMD could suggest treatment nonadherence, inadequate calcium or vitamin D intake, an unidentified secondary cause of osteoporosis, or treatment failure.48 However, a single-institution study found that although follow-up DEXA scanning for patients with osteoporosis was performed often, this rarely led to changes in treatment, even in patients found to have decreased BMD.49. ", Postgraduate Medicine: Primary care use of FRAX: absolute fracture risk assessment in postmenopausal women and older men., University of Sheffield: Calculation Tool, Welcome to FRAX.. FRAX is a clinical tool for assessing the risk of fractures in people with osteoporosis. FRAX: A tool for estimating your fracture risk. Fractions knowledge in grade 5 uniquely predicts student success in Algebra and . Do you regularly have >2 alcoholic drinks a day? This osteoporosis risk score calculator stratifies osteoporosis risk, especially useful in women with low bone density. car accidents) Falls over last 12 months Do you have a Bone Mineral Density (BMD) measurement? See Osteoporosis Risk Factors; Where other Osteoporosis risks exist, use FRAX Score or Osteoporosis SCORE Estimation; VI. With Frax, students come to understand that fractions are numbers too. Women younger than 65 years should be screened for osteoporosis if the estimated 10-year fracture risk equals or exceeds that of a 65-year-old white woman with no risk factors. by CJ Crandall 2019 Cited by 33 - Incident hip fractures and major . 2005-2023 Healthline Media a Red Ventures Company. More aggressive treatment usually includes a type of medication called bisphosphonates, such as alendronate (Fosamax) and ibandronate (Boniva). However, your doctor may suggest one earlier if you have a personal history of fractures or a family history of bone problems. A balanced diet consisting of vitamin D, calcium, protein, vegetables, and fruits is recommended; mononutrient dietary supplementation is unlikely to be helpful.24 Table 5 shows a comparison of nonpharmacologic therapies.1725, Table 6 summarizes pharmacologic treatments for osteoporosis, including bisphosphonates, raloxifene (Evista), teriparatide (Forteo), and denosumab (Prolia).16,2629, Mild upper gastrointestinal events, esophageal ulcerations, perforations, bleeding events, muscular and joint pains, Contraindications: abnormalities of the esophagus; inability to stand or sit upright for at least 30 minutes; hypersensitivity to any product component; increased risk of aspiration or dysphagia, 70 mg plus 2,800 IU or 5,600 IU per week, oral, 35 mg per week (day 1) plus 1,250 mg calcium per day (days 2 to 7 each week), oral, Contraindications: hypocalcemia creatinine clearance < 35 mL per minute per 1.73 m2 (0.58 mL per second per m2) and acute renal impairment; hypersensitivity to zoledronic acid or any components of this product, Pulmonary embolism, thromboembolic events, Contraindications: venous thromboembolism; pregnancy, women who may become pregnant, and breastfeeding mothers, 20 mcg per day for up to 2 years, subcutaneous, Arthralgia, pain, nausea, transient orthostatic hypotension, hypercalcemia, hyperuricemia, Contraindications: hypersensitivity to teriparatide or to any of its components; reactions have included angioedema and anaphylaxis. Enter your Femoral Neck T-score as a decimal number. Enter yes or no. Are you taking a prescription medicine for osteoporosis? Upgrade to Patient Pro Medical Professional? If you have a spine fracture, you are four times as likely to have another spine fracture. [corrected] Although guidelines for rescreening women with normal initial screening results are lacking, recent evidence suggests that intervals of at least four years appear safe.8,9, The USPSTF found insufficient evidence to recommend routine screening for osteoporosis in men.5 Men with a minimal trauma fracture who are older than 50 years or those with secondary causes associated with bone loss could be considered for screening. This may be asking you to have a bone scan, or talking to you about measures that can help prevent osteoporosis. Your doctor may recommend treatment to reduce your fracture risk. Some items on the FRAX score list of risk factors are manageable. M81.0 - Postmenopausal osteoporosis. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. Read our editorial policy. Yes No T-scores ? Fracture probability is also underestimated with multiple fractures. Inflammatory diseases like Lupus and Rheumatoid Arthritis that require more than 5 milligrams/day of steroids cause rapid bone loss by affecting the bone remodeling process. This decreases upper gastrointestinal adverse effects and allows for appropriate absorption. The need for follow-up bone mineral density testing in patients receiving treatment for osteoporosis is uncertain. MDCalc loves calculator creators researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. How has Covid-19 affected the treatment of osteoporosis? To help determine your risk for such an injury, doctors developed the Fracture Risk Assessment Tool (FRAX). Rheumatoid arthritis No Yes 10. Bisphosphonates should be used as first-line pharmacologic treatment for osteoporosis. English | Arabic | Bengali | Chinese Simplified | Chinese Traditional | Croatian | Czech | Danish | Dutch | Estonian | Farsi | Finnish | French | Georgian | German | Greek | Icelandic | Italian | Indonesian | Japanese | Korean | Lithuanian | Norwegian | Polish | Portuguese (Portugal) | Portuguese | Romanian | Russian | Serbia | Slovak | Spanish | Swedish | Thai | Turkish | Ukrainian, Individuals with fracture risk assessed since 1st June 2011, Age (between 40 and 90 years) or Date of Birth, Centre for Metabolic Bone Diseases, University of Sheffield, UK. The U.S. Preventive Services Task Force recommends using dual energy x-ray absorptiometry to screen all women 65 years and older, and younger women who have an increased fracture risk as determined by the FRAX Fracture Risk Assessment Tool. Genetics is one of the most important factors that determine your risk of fractures. Its a painless imaging test that uses low levels of radiation. GENDER female AGE These risk factors appear to have a dose-dependent effect, i.e. Osteoporosis-related fractures affect approximately one in two white women and one in five white men in their lifetime. Professional Reference tools are designed for health professionals to use. Secondary osteoporosis is caused by other health conditions (Table 4).2 Up to 30% of osteoporosis cases in postmenopausal women are estimated to be from a secondary cause.10 The estimate climbs to greater than 50% in men, premenopausal women, and perimenopausal women if vitamin D deficiency is included as a secondary cause.1113 In addition to performing a history and physical examination, expert consensus suggests a basic laboratory evaluation for all newly diagnosed patients to determine if there are contraindications for certain osteoporosis medications and to identify the more common secondary causes. Youll receive a 10-year risk percentage of a major osteoporotic fracture and a 10-year risk percentage of a hip fracture. SCORE = Race + Rheumatoid Arthritis + Fracture history + Estrogen + (3 x Age / 10) - (Weight in lbs / 10) The SCORE was developed after the study conducted by Lydick and colleagues as a stratification tool for post-menopausal women at risk of osteoporosis (consistent with BMD T scores <-2). The impact of fractures includes loss of function, significant costs, and increased mortality. The FRAXtool has been developed to evaluate fracture risk of patients. Multi-Factor Authentication (MFA) is required for all remote users Please install Symantec VIP on your mobile device to avoid any issues or delays with . It is a useful tool to aid clinical decision making about the use of pharmacologic therapies in patients with low bone mass. It usually develops unnoticed over many years until you have a fracture. The U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men. (2017). Renal insufficiency is a listed caution, but denosumab appears to be safe for patients with chronic kidney disease stages 1 to 3.45, Hormone Therapy. Getting more exercise, including weight-bearing activities, is helpful too. These may be lifestyle and dietary measures, or medication. Results: According to the FRAX algorithm (without BMD), 61.6% of our cohort require treatment. This content is owned by the AAFP. The National Osteoporosis Foundation also recommends screening all men 70 years and older, based on the assumption that this group has a similar osteoporotic fracture risk and treatment effectiveness as 65-year-old white women.1, Primary osteoporosis is related to aging and loss of gonadal function. The osteoporosis self-assessment tool (OST) 1 in women is a simple formula that predicts risk of osteoporosis for the patient based solely on current weight and age. Its a painless, non-invasive scan that measures bone strength in your hip and spine. T-scores are based on the NHANES reference values for women aged 20-29 years. It has been shown to decrease the occurrence of vertebral compression fractures only.16,26 Although calcitonin has modest analgesic properties in the setting of acute and chronic vertebral compression fracture, it is not considered first-line treatment for osteoporosis because more effective medications are available.16,41 There have also been reports of increased cancer rates associated with use of calcitonin.42, Teriparatide. [corrected] Although guidelines are lacking for rescreening women who have normal bone mineral density on initial screening, intervals of at least four years appear safe. If you are younger than 45, click here to take the Bone Health Quiz Do you have a question about how the Fracture Risk Calculator works for you? The American Bone Health Fracture Risk Calculator Version 3.0 estimates fracture risk for women and men over age 45. Check all that apply.Check all that apply. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Osteoporosis is a disease that weakens or thins your bones. Predicts risk of pathologic fracture in patients with long bone metastasis. A FRAX score can give you a better idea of your risk. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Bone Mineral Density Test: What to Expect. Previous Fracture No Yes 6. Long-term use of these medications is associated with several serious side effects, including fractures and jawbone deterioration. While the original paper describes the size of the lesion as a percentage of the cortex, in practice it is classified as a percentage of the width (diameter) of the bone at that level. The filter allows the FRAX score into the DXA report only when the patient does not meet the first two of the NOF treatment criteria (prior hip or vertebral fracture or T-score below 2.5) but could possibly meet the third NOF treatment criterion based on FRAX risk calculation: an untreated postmenopausal woman or man age 50 years or older . Garvan Institute Assessment Tool If it looks like your risk of an osteoporotic fracture is high in the next few years, talk with your doctor about medications, supplements, lifestyle changes, and anything else you can do to reduce your risk and protect yourself from a potentially life-altering fracture. If ages below or above are entered, the programme will compute probabilities at 40 and 90 year, respectively. 2005 - 2023 WebMD LLC. Because of the bone-weakening effects of menopause, 1 out of 2 women over the age of 50 will have a fracture related to osteoporosis. In patients with newly diagnosed osteoporosis, suggested laboratory tests to identify secondary causes include serum 25-hydroxyvitamin D, calcium, creatinine, and thyroid-stimulating hormone. The QRISK 3 algorithm calculates a person's risk of developing a heart attack or stroke over the next 10 years. Summary What it measures: The Fracture Risk Assessment Tool (FRAX) is a fracture risk calculator that estimates an individual's 10-year probability of incurring a hip or other major osteoporotic fracture. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of Defense, the U.S. Army Medical Corps, or the U.S. Army at large. If lifestyle changes are appropriate, your doctor may recommend: You will also be advised to reduce your fall risk in several ways. Knowing your 10-year risk for fractures will allow you and your doctor to make decisions about treatment. Privacy Policy. The QFracture and FRAX risk assessment tools predict the absolute risk of hip fracture, and major osteoporotic fractures (spine, wrist, or shoulder) over 10 years. Dr. John A Kanis Professor Emeritus, University of Sheffield Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. The most commonly recommended laboratory tests include serum 25-hydroxyvitamin D, calcium, creatinine, and thyroid-stimulating hormone levels.1,14, The National Osteoporosis Foundation recommends treatment of postmenopausal women and men with a personal history of hip or vertebral fracture, a T-score of 2.5 or less, or a combination of low bone mass (T-score between 1 and 2.5) and a 10-year probability of hip fracture of at least 3% or any major fracture of at least 20% as calculated by the FRAX Fracture Risk Assessment Tool.1 [corrected] The WHO recommendations are less specific, stating that persons with or at risk of osteoporosis should be considered for treatment.15 Randomized controlled trials of treatment have shown reduction of fractures for only two groups: those with a T-score of less than 2.5 and those who have already experienced a hip or vertebral fracture.16, Fall prevention is a priority for patients with osteoporosis because falls are more closely associated with fracture risk than is BMD.17 The USPSTF recommends exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling adults 65 years or older who are at increased risk of falls.18 A multicomponent exercise program that consists of weight-bearing resistance and balance training should be recommended. the tool is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck it gives the 10 year probability of a fracture - hip fracture and of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture) This enquires for a history of hip fracture in the patient's mother or father. Previously, clinicians could only estimate a 5-year fracture risk. 1.How do you rate your confidence that you could get and keep an erection? There is a direct relationship between tobacco and decreased bone density, whether its the smoking or the other risk factors of smokers, such as, being thinner, drinking more alcohol, being less physically active, and having a poor diet. In their most sophisticated form, the FRAX tool is computer-driven and is available on this site. What we know about vitamin D and bone health, American Bone Health calls on Americans to know their risk factors and take action to prevent falls and broken bones during Falls Prevention Awareness Week, Understanding How Obesity Affects Bone Health and Risk of Fractures, American Bone Health calls on American to Build Better Bones during National Osteoporosis Month 2022. Your QRISK score will tell you whether you are at low, moderate or high risk of developing CVD in the next 10 years. These include type I (insulin dependent) diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism or premature menopause (<45 years), chronic malnutrition, or malabsorption and chronic liver disease. The same absolute values are used in men. FRACTURE RISK CALCULATOR Fill out the following to estimate your fracture risk Full Name (optional) Sex? Other types of DEXA scans check a few bones, such as the hips, wrist, and spine. In their most sophisticated form, the FRAX tool is computer-driven and is available on this site. 2.When you had erections with sexual stimulation, how often were your erections hard enough for penetration? Calcitonin nasal spray is an antiresorptive agent approved for the treatment of postmenopausal osteoporosis. Introduction Practical tips and precautions Absolute fracture risk calculators Bone health is primarily determined by dual energy x-ray absorptiometry (DXA) scanning after women have been screened for possible disease. The intravenous bisphosphonates approved by the U.S. Food and Drug Administration for the treatment of postmenopausal osteoporosis are zoledronic acid (Reclast), 5 mg yearly (shown to decrease vertebral and hip fractures),16,26,36 and ibandronate, 3 mg every three months.37 Although these medications are expensive, they are useful for high-risk patients who are unable to tolerate or adhere to oral therapy. Other perimenopausal or postmenopausal women with risk factors for osteoporosis if willing to consider pharmacologic interventions: Excessive consumption of alcohol (> 2 drinks per day for women), Low body weight (< 58 kg [128 lb] or body mass index < 20 kg per m, Any history of long-term systemic glucocorticoid therapy ( 3 months), American College of Obstetricians and Gynecologists, Bone density screening no more than once every two years beginning at 65 years of age, unless new health risks develop, Selective screening in women younger than 65 years if they are postmenopausal and have other osteoporosis risk factors or fracture, In the absence of new risk factors, DEXA monitoring of therapy should not be repeated after BMD is determined to be stable or improved, In women 65 years and older and in men 70 years and older, In postmenopausal women and men 50 to 69 years of age; recommended based on risk factor profile, With vertebral imaging in those who have had a fracture to determine degree of disease severity, At DEXA facilities using accepted quality assurance measures, In women 65 years and older and in men 70 years and older to diagnose vertebral fractures if T-score is 1.5, In women 70 years and older and in men 80 years and older to diagnose vertebral fractures, regardless of T-score, In postmenopausal women and men 50 years and older with a low-trauma fracture, In postmenopausal women and men 50 to 69 years of age to diagnose vertebral fractures if there is height loss 4 cm (1.5 in), or recent or ongoing long-term glucocorticoid therapy, To check for causes of secondary osteoporosis, BMD testing one to two years after initiating therapy to reduce fracture risk and every two years thereafter, More frequent testing in certain clinical situations, Longer interval between repeat BMD tests for patients without major risk factors and who have an initial T-score in the normal or upper lowbone mass range, Risk factors: glucocorticoid use (> 3 months cumulative therapy in past year), high-risk medication use, hypogonadism or premature menopause (age < 45 years), malabsorption syndrome, hyperparathyroidism, other associated disorders, Low body weight (< 60 kg [132 lb]) or weight loss (> 10% of weight at 25 years of age), Vertebral fracture or osteopenia on radiography, Repeat BMD testing in one to three years and reassess risk in moderate- and high-risk groups, United Kingdom National Osteoporosis Guideline Group, Case finding for BMD assessment is based on risk factor assessment and comparison of risk to age- and sex-specific fracture probabilities, Screen for osteoporosis in women 65 years and older, and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors, Current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men, Central nervous system disorders (e.g., epilepsy, multiple sclerosis, Parkinson disease, spinal cord injury, stroke), Endocrine/metabolic disorders (adrenal insufficiency, athletic amenorrhea, Cushing syndrome, hemochromatosis, homocystinuria, primary hyperparathyroidism, hyperprolactinemia, hyperthyroidism, primary or secondary hypogonadism, premature menopause, thyrotoxicosis, type 1 diabetes mellitus), Gastrointestinal disorders (celiac disease, gastric bypass, inflammatory bowel disease, malabsorption, pancreatic insufficiency, primary biliary cirrhosis), Hematologic disorders (hemophilia, leukemia and lymphomas, monoclonal gammopathies, multiple myeloma, sickle cell disease, thalassemia), Human immunodeficiency virus infection or AIDS, Nutrition disorders (alcoholism, anorexia nervosa/bulimia, malnutrition, vitamin A excess, vitamin D deficiency), Anticonvulsants (e.g., phenobarbital, phenytoin [Dilantin]), Gonadotropin-releasing hormone agonists and antagonists, Thiazolidinediones (e.g., pioglitazone [Actos]), 4 drinks per day for men or 2 drinks per day for women, 2.5 cups of coffee or 5 cups of tea per day, Multicomponent exercise with strength and balance training, Consider drug discontinuation after 5 years in low-risk patients, Small risk of atypical femoral shaft fractures; osteonecrosis of the jaw, Alendronate/cholecalciferol (Fosamax Plus D), Muscular and joint pains; small risk of osteonecrosis of the jaw (especially older women with poor dental hygiene or cancer) Contraindications: hypocalcemia; pregnancy.