History:

• History of falls or concerned about falling
• Dietary calcium estimation:
  • Number of dairy servings x 300 mg + 300 mg in general diet (unless restrictive diet like vegan, keto, etc.)
• Loss of height:
  • 1.5 inches or 3.8 cm suggestive of vertebral fracture –> get spine radiograph to confirm
• Weight (especially <51 kg or 112 lbs)
• Medications (particularly glucocorticoids, antiepileptics, heparin)
• Family history of osteoporosis or parent with hip fracture

Physical exam:

• Oral examination (evaluating need for invasive dental work: fractured teeth, periodontal disease, inflammation, extractions or implants needed)
  • If invasive dental work needed, await clearance to start antiresorptive/anabolic osteoporosis therapy from treating dentist/surgeon OR at least 3 months from completion of dental work.
• Fall assessment:
  • Gait evaluation (abnormal suggest fall risk)
  • Sit to stand (difficulty suggests fall risk)

History:

Women:

• Weight upon graduation from high school
• Age at menarche and menopause

All:

• Prior fractures in adulthood
• Kidney stones (may suggest hypercalciuria)
• History of falls or concerned about falling
• Exercise (cardiovascular and strength)
• Nutrition/diet with emphasis on calcium intake
• Low weight (<51 kg or 112 lbs) or significant weight loss (>10% fluctuation)
• Loss of height (1.5 inches or 3.8 cm suggestive of vertebral fracture)*
• Medications (particularly glucocorticoids, antiepileptics, heparin)
• Family history of osteoporosis
• Comorbidities:
  • chronic inflammatory states, malabsorptive disorders, chronic major organ dysfunction (liver, kidney, heart, lungs),GERD/esophagitis/dysphagia, diabetes, thyroid dysfunction, parathyroid dysfunction, hypogonadal states
• Smoking
• Alcohol use

Physical

• Weight and BMI
• Oral examination (evaluating need for invasive dental work: fractured teeth, periodontal disease, inflammation, extractions or implants needed)
  • If invasive dental work needed, await clearance to start antiresorptive/anabolic osteoporosis therapy from treating dentist/surgeon OR at least 3 months from completion of dental work.
• Spine tenderness (suggestive of vertebral fractures)*
• Fall assessment:
  • Gait evaluation (abnormal suggest fall risk)
  • Sit to stand (difficulty suggests fall risk)
• Rib-pelvis distance (less than 2 finger widths suggestive of vertebral fracture) or wall-occiput distance (>0cm  suggestive of vertebral fracture)*

*If present, raises concern for vertebral fracture. Obtain spine radiograph to confirm.