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Osteoporosis pp 139–149Cite as

Osteoporosis Screening and Diagnosis

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Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Osteoporosis is a global public health problem that imposes a large economic and medical burden on individuals and societies. Early identification of adults with osteoporosis may allow for interventions to reduce future fractures. Osteoporosis assessment involves evaluation of clinical risk factors and, in many cases, measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA). Screening recommendations vary by country, but North American guidelines call for routine bone density testing of all women aged 65 years and older, as well as selected younger men and women with clinical risk factors. Other countries recommend a case-finding strategy among high-risk adults. There is controversy over the optimal BMD screening interval. Estimation of future fracture risk using fracture risk calculators (with or without BMD) can aid in determining who should be screened and/or treated for osteoporosis. Treatment is recommended on the basis of history of fragility fracture, presence of low BMD T-score, or prediction of a high future risk of fracture. Despite guidelines, rates of osteoporosis screening and treatment remain low.

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References

  1. Kanis JA, World Health Organization Scientific Group. Assessment of osteoporosis at the primary health care level Technical Report Sheffield. United Kingdom: World Health Organization Collaborating Centre for Metabolic Bone Diseases; 2008. p. 1–339.

    Google Scholar 

  2. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res. 2007;22(3):465–75.

    Article  PubMed  Google Scholar 

  3. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.

    Article  CAS  PubMed  Google Scholar 

  4. Lippuner K, Johansson H, Kanis JA, Rizzoli R. Remaining lifetime and absolute 10-year probabilities of osteoporotic fracture in swiss men and women. Osteoporos Int. 2009;20(7):1131–40.

    Article  CAS  PubMed  Google Scholar 

  5. Park C, Ha YC, Jang S, Jang S, Yoon HK, Lee YK. The incidence and residual lifetime risk of osteoporosis-related fractures in Korea. J Bone Miner Metab. 2011;29(6):744–51.

    Article  PubMed  Google Scholar 

  6. Pisani P, Renna MD, Conversano F, Casciaro E, Di Paola M, Quarta E, et al. Major osteoporotic fragility fractures: risk factor updates and societal impact. World J Orthop. 2016;7(3):171–81.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Roux C, Wyman A, Hooven FH, Gehlbach SH, Adachi JD, Chapurlat RD, et al. Burden of non-hip, non-vertebral fractures on quality of life in postmenopausal women: the global longitudinal study of osteoporosis in women (GLOW). Osteoporos Int. 2012;23(12):2863–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301(5):513–21.

    Article  CAS  PubMed  Google Scholar 

  9. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999;353(9156):878–82.

    Article  CAS  PubMed  Google Scholar 

  10. Forsén L, Sogaard AJ, Meyer HE, Edna T, Kopjar B. Survival after hip fracture: short and long-term excess mortality according to age and gender. Osteoporosis Int. 1999;10(1):73–8.

    Article  Google Scholar 

  11. Kanis JA, Johnell O, Oden A, Borgstrom F, Johansson H, De Laet C, et al. Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden. Osteoporos Int. 2005;16(1):6–14.

    Article  PubMed  Google Scholar 

  12. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12(12):989–95.

    Article  CAS  PubMed  Google Scholar 

  13. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR. Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res. 1999;14(5):821–8.

    Article  CAS  PubMed  Google Scholar 

  14. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2010;15(4):721–39.

    Article  Google Scholar 

  15. Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, et al. Assessment of fracture risk. Osteoporos Int. 2005;16(6):581–9.

    Article  PubMed  Google Scholar 

  16. Leslie WD. Clinical review: ethnic differences in bone mass--clinical implications. J Clin Endocrinol Metab. 2012;97(12):4329–40.

    Article  CAS  PubMed  Google Scholar 

  17. Wright NC, Saag KG, Curtis JR, Smith WK, Kilgore ML, Morrisey MA, et al. Recent trends in hip fracture rates by race/ethnicity among older US adults. J Bone Miner Res. 2012;27(11):2325–32.

    Article  PubMed  Google Scholar 

  18. Cauley JA, Lui LY, Ensrud KE, Zmuda JM, Stone KL, Hochberg MC, et al. Bone mineral density and the risk of incident nonspinal fractures in black and white women. JAMA. 2005;293(17):2102–8.

    Article  CAS  PubMed  Google Scholar 

  19. Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, et al. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res. 2005;20(2):185–94.

    Article  PubMed  Google Scholar 

  20. Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013;8:137.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Mazess R, Chesnut CH 3rd, McClung M, Genant H. Enhanced precision with dual-energy X-ray absorptiometry. Calcif Tissue Int. 1992;51(1):14–7.

    Article  CAS  PubMed  Google Scholar 

  22. Njeh CF, Fuerst T, Hans D, Blake GM, Genant HK. Radiation exposure in bone mineral density assessment. Appl Radiat Isot. 1999;50(1):215–36.

    Article  CAS  PubMed  Google Scholar 

  23. Lotz JC, Cheal EJ, Hayes WC. Fracture prediction for the proximal femur using finite element models: part I – linear analysis. J Biomech Eng. 1991;113(4):353–60.

    Article  CAS  PubMed  Google Scholar 

  24. Leslie WD, Tsang JF, Caetano PA, Lix LM. Manitoba bone density P. Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice. J Clin Endocrinol Metab. 2007;92(1):77–81.

    Article  CAS  PubMed  Google Scholar 

  25. Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, et al. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. 2003;18(11):1947–54.

    Article  PubMed  Google Scholar 

  26. Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20(7):1185–94.

    Article  PubMed  Google Scholar 

  27. Black DM, Cummings SR, Genant HK, Nevitt MC, Palermo L, Browner W. Axial and appendicular bone density predict fractures in older women. J Bone Miner Res. 1992;7(6):633–8.

    Article  CAS  PubMed  Google Scholar 

  28. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312(7041):1254–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO study group. World Health Organ Tech Rep Ser. 1994;843:1–129.

    Google Scholar 

  30. Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone. 2004;34(1):195–202.

    Article  CAS  PubMed  Google Scholar 

  31. Siris ES, Chen Y-T, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, et al. 128 bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004;164(10):1108–12.

    Article  PubMed  Google Scholar 

  32. Wainwright SA, Marshall LM, Ensrud KE, Cauley JA, Black DM, Hillier TA, et al. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab. 2005;90(5):2787–93.

    Article  CAS  PubMed  Google Scholar 

  33. FRAX. Fracture Risk Assessment Tool. Centre for Metabolic Bone Diseases UoS, UK. Available from: https://www.sheffield.ac.uk/FRAX/index.aspx.

  34. Dagan N, Cohen-Stavi C, Leventer-Roberts M, Balicer RD. External validation and comparison of three prediction tools for risk of osteoporotic fractures using data from population based electronic health records: retrospective cohort study. BMJ. 2017;356:i6755.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Leslie WD, Lix LM, Wu X, Manitoba Bone Density P. Competing mortality and fracture risk assessment. Osteoporos Int. 2013;24(2):681–8.

    Article  CAS  PubMed  Google Scholar 

  36. Giangregorio LM, Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, et al. FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res. 2012;27(2):301–8.

    Article  PubMed  Google Scholar 

  37. Schwartz AV, Vittinghoff E, Bauer DC, Hillier TA, Strotmeyer ES, Ensrud KE, et al. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA. 2011;305(21):2184–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA. Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int. 2011;22(3):839–47.

    Article  CAS  PubMed  Google Scholar 

  39. Kanis JA, Johansson H, Oden A, McCloskey EV. Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int. 2011;22(3):809–16.

    Article  CAS  PubMed  Google Scholar 

  40. McCloskey EV, Oden A, Harvey NC, Leslie WD, Hans D, Johansson H, et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res. 2016;31(5):940–8.

    Article  PubMed  Google Scholar 

  41. Hippisley-Cox J, Coupland C. Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. BMJ. 2012;344:e3427.

    Article  PubMed  Google Scholar 

  42. Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int. 2008;19(10):1431–44.

    Article  CAS  PubMed  Google Scholar 

  43. Garvin-website. Fracture risk calculator. Garvin Institute. Available from: www.garvan.org.au/promotions/bone-fracture-risk/calculator/.

  44. Rubin KH, Abrahamsen B, Friis-Holmberg T, Hjelmborg JV, Bech M, Hermann AP, et al. Comparison of different screening tools (FRAX(R), OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture. A population-based prospective study. Bone. 2013;56(1):16–22.

    Article  PubMed  Google Scholar 

  45. Leslie WD, Lix LM. Comparison between various fracture risk assessment tools. Osteoporos Int. 2014;25(1):1–21.

    Article  CAS  PubMed  Google Scholar 

  46. Viswanathan M, Reddy S, Berkman N, Cullen K, Middleton JC, Nicholson WK, et al. Screening to prevent osteoporotic fractures: updated evidence report and systematic review for the US preventive services task force. JAMA. 2018;319(24):2532–51.

    Article  PubMed  Google Scholar 

  47. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ. 2010;182(17):1864–73.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Camacho PM, Petak SM, Binkley N, Clarke BL, Harris ST, Hurley DL, et al. American Association of Clinical Endocrinologists and American College of endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis – 2016. Endocr Pract. 2016;22(Suppl 4):1–42.

    Article  PubMed  Google Scholar 

  49. Jeremiah MP, Unwin BK, Greenawald MH, Diagnosis CVE. Management of osteoporosis. Am Fam Physician. 2015;92(4):261–8.

    PubMed  Google Scholar 

  50. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int. 2014;25(10):2359–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Densitometry ISfC. 2015 ISCD official positions – adult. Middletown: International Society for Clinical Densitometry, Inc; 2015. Available from: http://www.iscd.org/official-positions/2015-iscd-official-positions-adult/.

  52. NAMS. Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause. 2010;17(1):25–54.. quiz 5-6

    Article  Google Scholar 

  53. Lim LS, Hoeksema LJ, Sherin K, Committee APP. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med. 2009;36(4):366–75.

    Article  PubMed  Google Scholar 

  54. Committee on Practice Bulletins-Gynecology TACoO, Gynecologists. ACOG Practice Bulletin N. 129. Osteoporosis. Obstet Gynecol. 2012;120(3):718–34.

    Article  Google Scholar 

  55. Watts NB, Adler RA, Bilezikian JP, Drake MT, Eastell R, Orwoll ES, et al. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(6):1802–22.

    Article  CAS  PubMed  Google Scholar 

  56. Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK, et al. Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148(9):680–4.

    Article  PubMed  Google Scholar 

  57. Leslie WD, Schousboe JT. A review of osteoporosis diagnosis and treatment options in new and recently updated guidelines on case finding around the world. Curr Osteoporos Rep. 2011;9(3):129–40.

    Article  PubMed  Google Scholar 

  58. Orimo H, Nakamura T, Hosoi T, Iki M, Uenishi K, Endo N, et al. Japanese 2011 guidelines for prevention and treatment of osteoporosis--executive summary. Arch Osteoporos. 2012;7:3–20.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Australia TRACoGPaO. Osteoporosis prevention diagnosis and management in postmenopausal women and men over 50 years of age. 2nd ed. East Melbourne: RACGP; 2017.

    Google Scholar 

  60. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57.

    Article  CAS  PubMed  Google Scholar 

  61. Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, et al. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int. 2008;19(10):1395–408.

    Article  CAS  PubMed  Google Scholar 

  62. Kern LM, Powe NR, Levine MA, Fitzpatrick AL, Harris TB, Robbins J, et al. Association between screening for osteoporosis and the incidence of hip fracture. Ann Intern Med. 2005;142(3):173–81.

    Article  PubMed  Google Scholar 

  63. Buist DS, LaCroix AZ, Brenneman SK, Abbott T 3rd. A population-based osteoporosis screening program: who does not participate, and what are the consequences? J Am Geriatr Soc. 2004;52(7):1130–7.

    Article  PubMed  Google Scholar 

  64. Nayak S, Roberts MS, Greenspan SL. Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women. Ann Intern Med. 2011;155(11):751–61.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Barr RJ, Stewart A, Torgerson DJ, Reid DM. Population screening for osteoporosis risk: a randomised control trial of medication use and fracture risk. Osteoporos Int. 2010;21(4):561–8.

    Article  CAS  PubMed  Google Scholar 

  66. Shepstone L, Lenaghan E, Cooper C, Clarke S, Fong-Soe-Khioe R, Fordham R, et al. Screening in the community to reduce fractures in older women (SCOOP): a randomised controlled trial. Lancet. 2018:391(10122):2017:741–7.

    Article  Google Scholar 

  67. Turner DA, Khioe RFS, Shepstone L, Lenaghan E, Cooper C, Gittoes N, et al. The cost-effectiveness of screening in the community to reduce osteoporotic fractures in older women in the UK: economic evaluation of the SCOOP study. J Bone Miner Res. 2018;33(5):845–51.

    Article  PubMed  Google Scholar 

  68. Rubin KH, Rothmann MJ, Holmberg T, Hoiberg M, Moller S, Barkmann R, et al. Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized risk-stratified osteoporosis strategy evaluation (ROSE) study. Osteoporos Int. 2018;29(3):567–78.

    Article  CAS  PubMed  Google Scholar 

  69. NBHA AMoNBH, Alliance. World Health Organization – WHO criteria for diagnosis of osteoporosis 2008. Available from: http://www.4bonehealth.org/education/world-health-organization-criteria-diagnosis-osteoporosis/.

  70. Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, Baim S, Favus MJ, Khosla S, et al. Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int. 2008;19(4):437–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Reid I, Horne AM, Mihov B, et al. Fracture prevention with zoledronate in older women with osteopenia. NEJM. 2018; https://doi.org/10.1056/NEJMoa1808082. [Epub ahead of print].

    Article  CAS  PubMed  Google Scholar 

  72. Donaldson MG, Palermo L, Ensrud KE, Hochberg MC, Schousboe JT, Cummings SR. Effect of alendronate for reducing fracture by FRAX score and femoral neck bone mineral density: the fracture intervention trial. J Bone Miner Res. 2012;27(8):1804–10.

    Article  CAS  PubMed  Google Scholar 

  73. Kanis JA, Johansson H, Oden A, McCloskey EV. A meta-analysis of the efficacy of raloxifene on all clinical and vertebral fractures and its dependency on FRAX. Bone. 2010;47(4):729–35.

    Article  CAS  PubMed  Google Scholar 

  74. Harvey NC, Kanis JA, Oden A, Nakamura T, Shiraki M, Sugimoto T, et al. Efficacy of weekly teriparatide does not vary by baseline fracture probability calculated using FRAX. Osteoporos Int. 2015;26(9):2347–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. McCloskey EV, Johansson H, Oden A, Harvey NC, Jiang H, Modin S, et al. The effect of Abaloparatide-SC on fracture risk is independent of baseline FRAX fracture probability: a post hoc analysis of the ACTIVE study. J Bone Miner Res. 2017;32(8):1625–31.

    Article  CAS  PubMed  Google Scholar 

  76. Kanis JA, Harvey NC, Cooper C, Johansson H, Oden A, McCloskey EV, et al. A systematic review of intervention thresholds based on FRAX : a report prepared for the National Osteoporosis Guideline Group and the international osteoporosis foundation. Arch Osteoporos. 2016;11(1):25.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Hillier TA, Stone KL, Bauer DC, Rizzo JH, Pedula KL, Cauley JA, et al. Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: the study of osteoporotic fractures. Arch Intern Med. 2007;167(2):155–60.

    Article  PubMed  Google Scholar 

  78. Leslie WD, Morin SN, Lix LM. Manitoba bone density P. Rate of bone density change does not enhance fracture prediction in routine clinical practice. J Clin Endocrinol Metab. 2012;97(4):1211–8.

    Article  CAS  PubMed  Google Scholar 

  79. Berger C, Langsetmo L, Joseph L, Hanley DA, Davison KS, Josse RG, et al. Association between change in BMD and fragility fracture in women and men. J Bone Miner Res. 2009;24(2):361–70.

    Article  PubMed  Google Scholar 

  80. Nguyen TV, Center JR, Eisman JA. Femoral neck bone loss predicts fracture risk independent of baseline BMD. J Bone Miner Res. 2005;20(7):1195–201.

    Article  PubMed  Google Scholar 

  81. Ahmed LA, Emaus N, Berntsen GK, Bjornerem A, Fonnebo V, Jorgensen L, et al. Bone loss and the risk of non-vertebral fractures in women and men: the Tromso study. Osteoporos Int. 2010;21(9):1503–11.

    Article  CAS  PubMed  Google Scholar 

  82. Berry SD, Samelson EJ, Pencina MJ, McLean RR, Cupples LA, Broe KE, et al. Repeat bone mineral density screening and prediction of hip and major osteoporotic fracture. JAMA. 2013;310(12):1256–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY, et al. Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med. 2012;366(3):225–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  84. Frost SA, Nguyen ND, Center JR, Eisman JA, Nguyen TV. Timing of repeat BMD measurements: development of an absolute risk-based prognostic model. J Bone Miner Res. 2009;24(11):1800–7.

    Article  PubMed  Google Scholar 

  85. Yu EW, Finkelstein JS. Bone density screening intervals for osteoporosis: one size does not fit all. JAMA. 2012;307(24):2591–2.

    Article  CAS  PubMed  Google Scholar 

  86. King AB, Fiorentino DM. Medicare payment cuts for osteoporosis testing reduced use despite tests' benefit in reducing fractures. Health Aff. 2011;30(12):2362–70.

    Article  Google Scholar 

  87. Overman RA, Farley JF, Curtis JR, Zhang J, Gourlay ML, Deal CL. DXA utilization between 2006 and 2012 in commercially insured younger postmenopausal women. J Clin Densitom. 2015;18(2):145–9.

    Article  PubMed  PubMed Central  Google Scholar 

  88. NCQA. NCQA – osteoporosis testing and management in older women (OTO, OMW). Available from: http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2017-table-of-contents/osteoporosis.

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Acknowledgments

I am grateful to Michael Cheney, NP, for his editing and thoughtful suggestions for this chapter.

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  1. Department of Medicine/Endocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Elaine W. Yu

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    Benjamin Z. Leder

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    Marc N. Wein

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Yu, E.W. (2020). Osteoporosis Screening and Diagnosis. In: Leder, B., Wein, M. (eds) Osteoporosis. Contemporary Endocrinology. Humana, Cham. https://doi.org/10.1007/978-3-319-69287-6_7

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