{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:05:57Z","timestamp":1792789557982,"version":"4.5.0"},"reference-count":47,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Oradea","id":[{"id":"https:\/\/ror.org\/00wzhv093","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00wzhv093","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Bone mineral density (BMD) is fundamental to osteoporosis assessment, but fracture risk is also shaped by fracture history, falls, frailty, secondary causes, age, sex, and treatment context. This narrative review examines clinically relevant information that modifies adult endocrine decision-making beyond the T-score. Methods: PubMed\/MEDLINE was searched through 28 June 2026; recent guidelines, consensus statements, systematic reviews, meta-analyses, and pivotal fracture-endpoint trials were prioritized. The exact search strings, filters, eligibility criteria, selection process, and prioritized guidance documents are provided in PubMed MEDLINE search strategies. Results: BMD should be interpreted with fracture history and clinical risk factors, while the applicability of T-scores differs by age and sex. FRAX, vertebral imaging, and trabecular bone score can refine assessment in selected patients. Very-high-risk patients may warrant early osteoanabolic or dual-action therapy followed by antiresorptive treatment, whereas antiresorptives remain appropriate for many high-risk patients. Denosumab requires planned continuity and a follow-on strategy; advanced chronic kidney disease requires particular attention to mineral metabolism and hypocalcemia risk. Conclusions: Contemporary osteoporosis care expands rather than replaces densitometry. Endocrine management should integrate valid DXA interpretation, fracture-risk urgency, reversible contributors, drug-specific safety, treatment feasibility, monitoring, and the next treatment phase.<\/jats:p>","DOI":"10.3390\/jcm15187258","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7258","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the T-Score: A Narrative Clinical Review of Adult Endocrine Osteoporosis Care"],"prefix":"10.3390","volume":"15","author":[{"given":"Laura Monica","family":"Georgescu","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Department of Medical Sciences, Endocrinology Discipline, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea-Diana","family":"Igna","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Department of Medical Sciences, Endocrinology Discipline, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia Cristina","family":"Popa T\u0103ut","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Department of Medical Sciences, Endocrinology Discipline, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca Anamaria","family":"Todera\u0219 Herla\u0219","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Department of Medical Sciences, Endocrinology Discipline, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0879-1903","authenticated-orcid":false,"given":"Ioana Adela","family":"Ra\u021biu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Department of Medical Sciences, Endocrinology Discipline, Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Nephrology Department, Bihor County Emergency Clinical Hospital, 12 Corneliu Coposu Street, 410469 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7780-1402","authenticated-orcid":false,"given":"Luis Miguel","family":"Luengo Perez","sequence":"additional","affiliation":[{"name":"Medical Sciences Department, Faculty of Medicine and Health Sciences, University of Extremadura, 06006 Badajoz, Spain"},{"name":"Clinical Nutrition and Dietetics Unit, Endocrinology and Nutrition Section, Badajoz University Hospital, 06008 Badajoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3113-7232","authenticated-orcid":false,"given":"Nicoleta Ana Maria","family":"Pa\u0219cal\u0103u","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 1st December Square 10, 410073 Oradea, Romania"},{"name":"Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1001\/jama.2025.6003","article-title":"Osteoporosis: A Review","volume":"334","author":"Morin","year":"2025","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1016\/S0140-6736(25)01385-6","article-title":"Osteoporosis","volume":"406","author":"Ye","year":"2025","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"ziag006","DOI":"10.1093\/jbmrpl\/ziag006","article-title":"Time to reframe osteoporosis: A position statement to characterize the osteoporosis care gap","volume":"10","author":"Paskins","year":"2026","journal-title":"JBMR Plus"},{"key":"ref_4","unstructured":"International Society for Clinical Densitometry (2026, August 28). Official Adult Positions 2023. Available online: https:\/\/iscd.org\/official-positions-2023\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00198-021-05900-y","article-title":"The clinician\u2019s guide to prevention and treatment of osteoporosis","volume":"33","author":"LeBoff","year":"2022","journal-title":"Osteoporos. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s11657-025-01588-3","article-title":"The 2024 UK clinical guideline for the prevention and treatment of osteoporosis","volume":"20","author":"Gregson","year":"2025","journal-title":"Arch. Osteoporos."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"US Preventive Services Task Force, Nicholson, W.K., Silverstein, M., Wong, J.B., Chelmow, D., Coker, T.R., Davis, E.M., Ja\u00e9n, C.R., Krousel-Wood, M., and Lee, S. (2025). Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA, 333, 498\u2013508.","DOI":"10.1001\/jama.2024.27154"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1093\/jbmr\/zjae119","article-title":"Goal-directed osteoporosis treatment: ASBMR\/BHOF task force position statement 2024","volume":"39","author":"Cosman","year":"2024","journal-title":"J. Bone Miner. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101452","DOI":"10.1016\/j.jocd.2023.101452","article-title":"Clinical Use of Trabecular Bone Score: The 2023 ISCD Official Positions","volume":"27","author":"Goel","year":"2024","journal-title":"J. Clin. Densitom."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00198-021-05911-9","article-title":"The impact of fracture liaison services on subsequent fractures and mortality: A systematic literature review and meta-analysis","volume":"32","author":"Li","year":"2021","journal-title":"Osteoporos. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00198-019-05176-3","article-title":"Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures","volume":"31","author":"Kanis","year":"2020","journal-title":"Osteoporos. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1210\/clinem\/dgaa048","article-title":"Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update","volume":"105","author":"Shoback","year":"2020","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1146\/annurev-med-050124-040555","article-title":"Recent Advances in Osteoporosis Therapeutics","volume":"77","author":"Langdahl","year":"2026","journal-title":"Annu. Rev. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11914-026-00967-0","article-title":"Sequential Versus Step-Therapy Approaches for Osteoporosis Management in Orthopedic Subspecialties","volume":"24","author":"Salman","year":"2026","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"564","DOI":"10.4158\/GL-2020-0524","article-title":"American Association of Clinical Endocrinologists\/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update","volume":"26","author":"Camacho","year":"2020","journal-title":"Endocr. Pract."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1007\/s40520-022-02100-4","article-title":"Management of patients at very high risk of osteoporotic fractures through sequential treatments","volume":"34","author":"Curtis","year":"2022","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101440","DOI":"10.1016\/j.jocd.2023.101440","article-title":"Follow-up Bone Mineral Density Testing: 2023 Official Positions of the International Society for Clinical Densitometry","volume":"27","author":"Gani","year":"2024","journal-title":"J. Clin. Densitom."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1136\/bjsports-2021-104634","article-title":"Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis","volume":"56","author":"Skelton","year":"2022","journal-title":"Br. J. Sports Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S2213-8587(21)00347-8","article-title":"Bone fragility in diabetes: Novel concepts and clinical implications","volume":"10","author":"Hofbauer","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2405","DOI":"10.1002\/acr.25240","article-title":"2022 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis","volume":"75","author":"Humphrey","year":"2023","journal-title":"Arthritis Care Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1002\/jbmr.4677","article-title":"Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop","volume":"37","author":"Bilezikian","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_22","first-page":"3655","article-title":"Effect of Thyroid-Stimulating Hormone Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-Analysis","volume":"106","author":"Ku","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1038\/s41584-024-01094-9","article-title":"Evidence-Based Guideline for the management of osteoporosis in men","volume":"20","author":"Fuggle","year":"2024","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_24","unstructured":"DailyMed (2026, September 15). FOSAMAX (Alendronate Sodium): U.S. Prescribing Information, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/fda\/fdaDrugXsl.cfm?setid=14e931fd-2c5f-4d90-b7db-5980706f4a56."},{"key":"ref_25","unstructured":"DailyMed (2026, September 15). ACTONEL (Risedronate Sodium): U.S. Prescribing Information, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=4423d70a-b120-4653-bcf3-0c5ea8b97b0e."},{"key":"ref_26","unstructured":"DailyMed (2026, September 15). RECLAST (Zoledronic Acid) Injection: U.S. Prescribing Information, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=3c79ff9c-a6f4-405d-b19c-7e473a61dedc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1056\/NEJMoa0809493","article-title":"Denosumab for Prevention of Fractures in Postmenopausal Women with Osteoporosis","volume":"361","author":"Cummings","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/jbmr.3337","article-title":"Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension","volume":"33","author":"Cummings","year":"2018","journal-title":"J. Bone Miner. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"105954","DOI":"10.1016\/j.jbspin.2025.105954","article-title":"Strategies for denosumab discontinuation in postmenopausal osteoporosis","volume":"93","author":"Degboe","year":"2026","journal-title":"Jt. Bone Spine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.7326\/M24-0013","article-title":"The Effect of Denosumab on Risk for Emergently Treated Hypocalcemia by Stage of Chronic Kidney Disease: A Target Trial Emulation","volume":"178","author":"Bird","year":"2025","journal-title":"Ann. Intern. Med."},{"key":"ref_31","unstructured":"DailyMed (2026, September 15). PROLIA (Denosumab) Injection: U.S. Prescribing Information, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=49e5afe9-a0c7-40c4-af9f-f287a80c5c88."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/S0140-6736(17)32137-2","article-title":"Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): A multicentre, double-blind, double-dummy, randomised controlled trial","volume":"391","author":"Kendler","year":"2018","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1001\/jama.2016.11136","article-title":"Effect of Abaloparatide vs. Placebo on New Vertebral Fractures in Postmenopausal Women with Osteoporosis: A Randomized Clinical Trial","volume":"316","author":"Miller","year":"2016","journal-title":"JAMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1056\/NEJMoa1708322","article-title":"Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis","volume":"377","author":"Saag","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1056\/NEJMoa1607948","article-title":"Romosozumab Treatment in Postmenopausal Women with Osteoporosis","volume":"375","author":"Cosman","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_36","unstructured":"DailyMed (2026, September 15). EVENITY (Romosozumab-Aqqg) Injection: U.S. Prescribing Information, Available online: https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=471baba2-7154-4488-9891-0db2f46791e7."},{"key":"ref_37","unstructured":"European Medicines Agency (2026, September 15). Evenity (Romosozumab): EPAR Product Information. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/evenity-epar-product-information_en.pdf."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.jor.2025.10.014","article-title":"The efficacy and safety of romosozumab sequential therapy in postmenopausal women: A systematic review and meta-analysis","volume":"72","author":"Li","year":"2026","journal-title":"J. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1210\/clinem\/dgaa756","article-title":"Fracture Risk and Management of Discontinuation of Denosumab Therapy: A Systematic Review and Position Statement by ECTS","volume":"106","author":"Tsourdi","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1016\/S0140-6736(96)07088-2","article-title":"Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures","volume":"348","author":"Black","year":"1996","journal-title":"Lancet"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1056\/NEJMoa067312","article-title":"Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis","volume":"356","author":"Black","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1016\/S0140-6736(15)61120-5","article-title":"Denosumab and teriparatide transitions in postmenopausal osteoporosis (the DATA-Switch study): Extension of a randomised controlled trial","volume":"386","author":"Leder","year":"2015","journal-title":"Lancet"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s00198-025-07422-3","article-title":"Update on the role of bone turnover markers in the diagnosis and management of osteoporosis: A consensus paper from ESCEO, IOF, and IFCC","volume":"36","author":"Bhattoa","year":"2025","journal-title":"Osteoporos. Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1093\/ndt\/gfaa192","article-title":"European Consensus Statement on the diagnosis and management of osteoporosis in chronic kidney disease stages G4-G5D","volume":"36","author":"Evenepoel","year":"2021","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"210","DOI":"10.52312\/jdrs.2024.1957","article-title":"Pregnancy- and lactation-related bone fragility: The hidden risk","volume":"36","author":"Sezgin","year":"2025","journal-title":"Jt. Dis. Relat. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.ecl.2024.05.003","article-title":"Bone Metabolism, Bone Mass, and Bone Structure During Pregnancy and Lactation: Normal Physiology and Pregnancy and Lactation-Associated Osteoporosis","volume":"53","author":"Cohen","year":"2024","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Gak, N., Abbara, A., Dhillo, W.S., Keen, R., and Comninos, A.N. (2024). Current and future perspectives on pregnancy and lactation-associated osteoporosis. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1494965"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7258\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:27:14Z","timestamp":1790076434000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7258"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":47,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187258"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187258","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}