Position Paper

Osteoporosis International

, Volume 25, Issue 5, pp 1439-1443

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group

  • E. S. SirisAffiliated withDivision of Endocrinology, Department of Medicine, Columbia University Medical Center Email author 
  • , R. AdlerAffiliated withSchool of Medicine, Virginia Commonwealth University
  • , J. BilezikianAffiliated withDivision of Endocrinology, Department of Medicine, Columbia University Medical Center
  • , M. BologneseAffiliated withBethesda Health Research
  • , B. Dawson-HughesAffiliated withJean Mayer USDA Human Nutrition Research Center on Aging, Bone Metabolism Laboratory, Tufts University
  • , M. J. FavusAffiliated withDepartment of Medicine, University of Chicago
  • , S. T. HarrisAffiliated withDepartment of Endocrinology and Metabolism, University of California
  • , S. M. Jan de BeurAffiliated withDivision of Endocrinology, Johns Hopkins University
  • , S. KhoslaAffiliated withMayo Clinic
    • , N. E. LaneAffiliated withSchool of Medicine, University of California
    • , R. LindsayAffiliated withHelen Hayes Hospital
    • , A. D. NanaAffiliated withUniversity of North Texas Health Science Center
    • , E. S. OrwollAffiliated withOregon Health & Science University
    • , K. SaagAffiliated withDivision of Clinical Immunology and Rheumatology, University of Alabama
    • , S. SilvermanAffiliated withBone Health Center, Cedars-Sinai Medical Center
    • , N. B. WattsAffiliated withOsteoporosis and Bone Health Services, Mercy Health Physicians



Osteoporosis causes an elevated fracture risk. We propose the continued use of T-scores as one means for diagnosis but recommend that, alternatively, hip fracture; osteopenia-associated vertebral, proximal humerus, pelvis, or some wrist fractures; or FRAX scores with ≥3 % (hip) or 20 % (major) 10-year fracture risk also confer an osteoporosis diagnosis.


Osteoporosis is a common disorder of reduced bone strength that predisposes to an increased risk for fractures in older individuals. In the USA, the standard criterion for the diagnosis of osteoporosis in postmenopausal women and older men is a T-score of ≤ −2.5 at the lumbar spine, femur neck, or total hip by bone mineral density testing.


Under the direction of the National Bone Health Alliance, 17 clinicians and clinical scientists were appointed to a working group charged to determine the appropriate expansion of the criteria by which osteoporosis can be diagnosed.


The group recommends that postmenopausal women and men aged 50 years should be diagnosed with osteoporosis if they have a demonstrable elevated risk for future fractures. This includes having a T-score of less than or equal to −2.5 at the spine or hip as one method for diagnosis but also permits a diagnosis for individuals in this population who have experienced a hip fracture with or without bone mineral density (BMD) testing and for those who have osteopenia by BMD who sustain a vertebral, proximal humeral, pelvic, or, in some cases, distal forearm fracture. Finally, the term osteoporosis should be used to diagnose individuals with an elevated fracture risk based on the World Health Organization Fracture Risk Algorithm, FRAX.


As new ICD-10 codes become available, it is our hope that this new understanding of what osteoporosis represents will allow for an appropriate diagnosis when older individuals are recognized as being at an elevated risk for fracture.


Clinical diagnosis Criteria Osteoporosis Position statement