• E. Michael Lewiecki


Osteoporosis is a common systemic skeletal disease characterized by low bone strength leading to increased risk of fracture. The occurrence of a fracture is associated with serious clinical consequences that include pain, disability, loss of independence, and death. Osteoporosis is diagnosed by measuring bone mineral density (BMD) or in some cases by the presence of a fragility fracture or high fracture probability independently of BMD. Evaluation for secondary causes of osteoporosis provides an opportunity to identify and mitigate potentially reversible risk factors for fracture. Treatment of osteoporosis includes healthy lifestyle and good nutrition, prevention of falls, avoiding exposure to skeletal toxins, and pharmacological therapy to reduce fracture risk, when appropriate. A treated patient should be followed to assure adherence to therapy, response to therapy, and achievement of an acceptable level of fracture risk.


Osteoporosis Fracture Diagnosis Evaluation Treatment ECHO 



In the past year, E. Michael Lewiecki has received institutional grant/research support from Amgen, Merck, and Eli Lilly; he has served on scientific advisory boards for Amgen, Merck, Eli Lilly, Radius Health, Shire, AbbVie, and Alexion; he serves on the speakers’ bureau for Shire and Alexion.


  1. 1.
    US Department of Health and Human Services. Bone health and osteoporosis: a report of the surgeon general. Rockville: US Department of Health and Human Services, Office of the Surgeon General; 2004.Google Scholar
  2. 2.
    International Osteoporosis Foundation. Osteoporosis. Accessed 30 Nov 2016.
  3. 3.
    Khosla S, Shane EA. Crisis in the treatment of osteoporosis. J Bone Miner Res. 2016;31(8):1485–7.CrossRefGoogle Scholar
  4. 4.
    WHO Study Group on Assessment of Fracture Risk and its Application to Screening for Postmenopausal Osteoporosis. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva: World Health Organization; 1994.Google Scholar
  5. 5.
    Shepherd JA, Schousboe JT, Broy SB, Engelke K, Leslie WD. Executive summary of the 2015 ISCD position development conference on advanced measures from DXA and QCT: fracture prediction beyond BMD. J Clin Densitom. 2015;18(3):274–86.CrossRefGoogle Scholar
  6. 6.
    Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int. 2014;25(5):1439–43.CrossRefGoogle Scholar
  7. 7.
    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 – executive summary. Endocr Pract. 2016;22(9):1111–8.CrossRefGoogle Scholar
  8. 8.
    Krieg MA, Barkmann R, Gonnelli S, Stewart A, Bauer DC, Del Rio BL, et al. Quantitative ultrasound in the management of osteoporosis: the 2007 ISCD Official Positions. J Clin Densitom. 2008;11(1):163–87.CrossRefGoogle Scholar
  9. 9.
    Lewiecki EM, Binkley N, Morgan SL, Shuhart CR, Camargos BM, Carey JJ, et al. Best practices for dual-energy X-ray absorptiometry measurement and reporting: International Society for Clinical Densitometry Guidance. J Clin Densitom. 2016;19(2):127–40.CrossRefGoogle Scholar
  10. 10.
    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.CrossRefGoogle Scholar
  11. 11.
    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.CrossRefGoogle Scholar
  12. 12.
    De Laet C, Oden A, Johansson H, Johnell O, Jonsson B, Kanis JA. The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach. Osteoporos Int. 2005;16(3):313–8.CrossRefGoogle Scholar
  13. 13.
    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.CrossRefGoogle Scholar
  14. 14.
    Lewiecki EM. Evaluation of the patient at risk for osteoporosis. In: Marcus R, Feldman D, Dempster DW, Luckey M, Cauley JA, editors. Osteoporosis, vol. 2. 4th ed. Waltham: Elsevier; 2013. p. 1481–504.CrossRefGoogle Scholar
  15. 15.
    Lewiecki EM, Laster AJ. Clinical applications of vertebral fracture assessment by dual-energy X-ray absorptiometry. J Clin Endocrinol Metab. 2006;91(11):4215–22.CrossRefGoogle Scholar
  16. 16.
    Drake MT, Clarke BL, Lewiecki EM. The pathophysiology and treatment of osteoporosis. Clin Ther. 2015;37(6):1837–50.CrossRefGoogle Scholar
  17. 17.
    Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA, et al. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial. JAMA. 2016;316(7):722–33.CrossRefGoogle Scholar
  18. 18.
    Cosman F, Crittenden DB, Adachi JD, Binkley N, Czerwinski E, Ferrari S, et al. Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med. 2016;375(16):1532–43.CrossRefGoogle Scholar
  19. 19.
    Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD. Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res. 2014;29(9):1929–37.CrossRefGoogle Scholar
  20. 20.
    Cramer JA, Gold DT, Silverman SL, Lewiecki EM. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int. 2007;18(8):1023–31.CrossRefGoogle Scholar
  21. 21.
    National Osteoporosis Foundation. Bone health index survey final report. Unpublished data; Arlington, VA, USA. 2016.Google Scholar
  22. 22.
    Lewiecki EM, Adler RA, Curtis JR, Gagel R, Saag KG, Singer AJ, et al. Hip fractures and declining DXA testing: at a breaking point? J Bone Miner Res. 2016;31(Suppl):S26.Google Scholar
  23. 23.
    Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007;22(10):1479–89.CrossRefGoogle Scholar
  24. 24.
    Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29(1):1–23.CrossRefGoogle Scholar
  25. 25.
    Adler RA, El-Hajj Fuleihan G, Bauer DC, Camacho PM, Clarke BL, Clines GA, et al. Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2016;31(1):16–35.CrossRefGoogle Scholar
  26. 26.
    McClung MR. Cancel the denosumab holiday. Osteoporos Int. 2016;27(5):1677–82.CrossRefGoogle Scholar
  27. 27.
    Lewiecki EM, Cummings SR, Cosman F. Treat-to-target for osteoporosis: is now the time? J Clin Endocrinol Metab. 2013;98(3):946–53.CrossRefGoogle Scholar
  28. 28.
    Cummings SR, Cosman F, Eastell R, Reid IR, Mehta M, Lewiecki EM. Goal-directed treatment of osteoporosis. J Bone Miner Res. 2013;28(3):433–8.CrossRefGoogle Scholar
  29. 29.
    Cummings SR, Cosman F, Lewiecki EM, Schousboe JT, Bauer DC, Black DM, et al. Goal-directed treatment for osteoporosis: a progress report from the ASBMR-NOF working group on goal-directed treatment for osteoporosis. J Bone Miner Res. 2017;32(1):3–10.CrossRefGoogle Scholar
  30. 30.
    National Bone Health Alliance. Fracture prevention central 2016 [updated March 28, 2016]. Available from:
  31. 31.
    International Osteoporosis Foundation. Capture the fracture 2016 [updated March 28, 2016]. Available from:
  32. 32.
    Tosi LL, Gliklich R, Kannan K, Koval KJ. The American Orthopaedic Association’s “Own the Bone” initiative to prevent secondary fractures. J Bone Joint Surg Am. 2008;90(1):163–73.CrossRefGoogle Scholar
  33. 33.
    Solomon DH, Patrick AR, Schousboe J, Losina E. The potential economic benefits of improved postfracture care: a cost-effectiveness analysis of a fracture liaison service in the US health-care system. J Bone Miner Res. 2014;29(7):1667–74.CrossRefGoogle Scholar
  34. 34.
    Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, et al. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199–207.CrossRefGoogle Scholar
  35. 35.
    Lewiecki EM, Boyle JF, Arora S, Bouchonville MF 2nd, Chafey DH. Telementoring: a novel approach to reducing the osteoporosis treatment gap. Osteoporos Int. 2017;28(1):407–11.CrossRefGoogle Scholar
  36. 36.
    Lewiecki EM, Bouchonville MF 2nd, Chafey DH, Bankhurst A, Arora S. Bone Health ECHO: telementoring to improve osteoporosis care. Women’s Health (Lond Engl). 2016;12(1):79–81.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • E. Michael Lewiecki
    • 1
  1. 1.New Mexico Clinical Research & Osteoporosis CenterAlbuquerqueUSA

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