Osteoporosis

What it is

Osteoporosis is defined by a DEXA T-score ≤ −2.5 SD at hip or spine, or by a fragility fracture (low-trauma hip, vertebral, or wrist fracture).

Why it matters

• Hip fracture in older adults carries ~25% 1-year mortality.
• Vertebral fractures cause chronic pain, height loss, kyphosis, reduced respiratory function.
• Most cases are silent before fracture.

Risk factors

• Age, female sex, low body weight, family history.
• Menopause (estrogen loss accelerates bone loss).
• Long-term glucocorticoid use.
• Hyperthyroidism, hyperparathyroidism.
• Vitamin D and calcium inadequacy.
• Smoking, excess alcohol.
• Sedentary lifestyle.

Screening

• DEXA at age 65 (women) / 70 (men), earlier if risk factors.
• FRAX 10-year fracture risk calculator integrates clinical factors.

What helps

• Resistance + impact loading exercise.
• Adequate calcium (1000–1200 mg/day, ideally from food).
• Vitamin D adequacy.
• Protein adequacy.
• Reduced fall risk (balance, stability, vision, polypharmacy review).

Pharmacology

• Bisphosphonates (alendronate, zoledronate) — first-line; reduce fracture by ~40–70%.
• Denosumab — RANK ligand inhibitor.
• Anabolics (teriparatide, abaloparatide, romosozumab) — for severe cases.
• HRT — effective in postmenopausal women, with timing considerations.

Related entries

HRT, DEXA, Vitamin D, Exercise.