Despite low T scores (-2.5 or worse), what is the actual fracture risk in relatively younger patients (early 50s to mid 60s) with low BMD?   

Should this patient population be treated differently?

At our institution, we have started using EPIC to screen many patients for osteoporosis and our DXA rates have gone up. I am wondering about patients in their early 50s to mid-60s who have T scores in the spine <-3.0. It seems to be happening more often with increased imaging. Would you commit this patient to "on/off" treatment for the rest of their life? Is there any data showing that despite the osteoporosis, fracture risk is very low in this age group? Obviously, by guidelines treatment is warranted, but curious to hear more about your thoughts on fracture rates in this age group. It seems that now that we are screening more people in this age group, we are finding a lot of osteoporosis at a young age. Are there studies that follow this age group and see if they use anabolic at this age, that the treatment will be maintained over their lifetime?