This CPB has been revised to add or update the following criteria for Prolia (denosumab) therapy: (i) updated postmenopausal osteoporosis indicator from "higher" to "very high" fracture risk, (ii) revised the definition of very low T-score from -3.5 to -3; (iii) added teriparatide (Bonsity) as an option for previous injectable osteoporosis therapy that the member may have failed for postmenopausal osteoporosis, (iv) for glucocorticoid-induced osteoporosis, added initiating glucocorticoid therapy "at an equivalent prednisone dose of greater than or equal to 2.5 mg/day for 3 months or more", (v) for breast cancer, updated adjuvant "aromatase inhibitor" to adjuvant "endocrine" therapy to align with NCCN nomenclature, and (vi) for continuation of therapy, added member has experienced clinical benefit as evidenced by a bone mass measurement showing an improvement or stabilization in T-score compared with the previous bone mass measurement and member has not experienced any adverse effects; or member has received less than 24 months of therapy and has experienced clinical benefit as evidenced by no adverse events during therapy (i.e., no clinically significant adverse reaction to the requested drug, no new fracture seen on radiography), and updated to include members who are currently receiving the requested medication through a "previously authorized" pharmacy or medical benefit. The criteria for Xgeva (denosumab) therapy was updated for bone metastases from a solid tumor to state "prevention of skeletal-related events" (Previous version stated "treatment"). The appendices has been updated to: (i) add to Appendix A Clinical Reasons to Avoid Oral Bisphosphonates "Presence of anatomic or functional esophageal abnormalities that might delay transit of the tablet (e.g. achalasia, stricture, or dysmotility)" and "Presence of documented or potential gastrointestinal malabsorption (e.g. gastric bypass procedures, celiac disease, Crohn’s disease, infiltrative disorders, etc.)" and removed "Esophageal abnormalities that delay emptying such as stricture or achalasia"; and (ii) add to Appendix B the following statement for major osteoporotic fracture: "including fractures of the spine (clinical), hip, wrist, or humerus".