Optimizing Osteoporosis Management in Endocrinology: Integrating Diagnostics and Addressing Disparities

Amid the dynamic field of endocrinology, osteoporosis management is evolving, driven by advanced diagnostic tools and growing awareness of socioeconomic disparities. With widely used tools like FRAX and recent society guidelines, the focus is increasingly on equitable care across socioeconomic groups, though progress depends on addressing structural barriers in access and adherence.

DXA, the standard bone density test, provides precise BMD measurements used with clinical criteria (e.g., T-score ≤ −2.5 or prior fragility fracture) to diagnose osteoporosis. For instance, the FRAX 10-year fracture risk calculator offers a multifactorial approach that assesses fracture risk beyond bone mineral density, complementing BMD to estimate 10-year fracture probability and inform treatment decisions.

Validated risk calculators and standardized DXA use are being adopted to identify high-risk patients earlier. Guideline-directed screening (for example, USPSTF recommends DXA for women aged 65 and older and for younger women at increased risk) uses risk calculators like FRAX to target earlier identification. Incorporating FRAX alongside DXA may standardize risk stratification; improved outcomes depend on initiating and adhering to effective therapy. Emerging data from validation studies and conference abstracts highlight growing interest in risk-based screening approaches.

Managing osteoporosis effectively amidst these advances requires addressing socioeconomic disparities head-on—including inequities in access to DXA, risk assessment, and timely treatment initiation. Pandemic-related disruptions reduced DXA utilization and interrupted fracture liaison services in many settings, widening existing gaps and highlighting the necessity for targeted responses. Ensuring equitable access to cutting-edge diagnostics and treatments remains a critical concern, particularly when socioeconomic limitations hinder healthcare delivery. Even when FRAX and DXA identify high risk, cost, coverage, and clinic access often delay treatment.

Culturally tailored education and care models offer pathways to overcoming treatment barriers. Implementation studies suggest culturally tailored education and navigation can improve adherence.

Key takeaways:

• Risk calculators like FRAX complement BMD to estimate 10-year fracture probability and guide treatment decisions.
• Screening recommendations (for example, USPSTF) help standardize who should be screened; better outcomes hinge on initiating and adhering to effective therapy.
• Equity requires addressing gaps in access to DXA, risk assessment, and timely treatment—barriers that widened during pandemic disruptions.
• Culturally tailored education and navigation may help improve adherence and narrow treatment gaps.