Osteoporosis when left untreated can have serious developments promoting multiple fractures with different functional consequences.
If the woman has suffered a low-trauma fracture, presumed to be due to osteoporosis, then treatment should be started, once secondary causes of osteoporosis have been excluded. Measurement of bone density by DXA would be useful as a baseline. (The same can be said of men). If the woman has not had a fracture, but has a low bone density, then some assessment of her other risk factors should be done e.g. FRAX, Garvan, Q-Fracture, and treatment started if she is at high risk. Treatment thresholds may also vary according to local country guidelines
Consider all adults with a history of vertebral fracture, hip fracture, proximal humerus, ankle, pelvis or distal forearm fracture at higher than average risk for a future fracture. So you have to review primarily the lifestyle risk factors (smoke, calcium daily intake…). A DEXA scan must to be obtained from these patients. All men and postmenopausal women with low-impact fracture are potential candidates for pharmacologic treatment.
You have to exclude also that patients are affected by ostemalacia. Women over age 70 with prior fracture are candidates for osteoporosis therapy even without bone density testing.
Pay attention: the accuracy of FRAX calculated without a DXA value is VERY low
I agree entirely with Dr. Swan Yeap. Independently from the history past fractures or not, if somebody is at risk (osteodensitometry - T-score less than -2.5), he or she should receive antiosteoporotic medications.
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