Understanding osteoporosis
Osteoporosis is a condition where bone density and quality are reduced, leading to increased fracture risk — often from minimal trauma (a fall from standing height or less). It affects approximately 1 in 3 women and 1 in 5 men over 50, and is often silent until a fracture occurs. Vertebral compression fractures (causing back pain and height loss) and hip fractures are the most serious consequences.
Risk factors include advancing age, female sex, family history, low body weight, smoking, excessive alcohol, prolonged immobility, and certain medications (e.g., long-term corticosteroids). Secondary causes (hyperparathyroidism, coeliac disease, vitamin D deficiency, hypogonadism) should be screened for and managed.
- Risk factors — age, sex, family history, low BMI, smoking, alcohol, immobility
- Vertebral fractures — back pain, height loss, kyphosis (dowager's hump)
- Hip fractures — serious injury, often requiring surgery, significant morbidity
- Wrist fractures — often the first sign of osteoporosis in younger postmenopausal women
- Height loss >3 cm — may indicate silent vertebral fractures
- Prolonged corticosteroid use — major modifiable risk factor
Related: Orthopedics → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Assessment and management
Bone density is measured by DEXA scan (dual-energy X-ray absorptiometry), which provides a T-score comparing your bone density to a healthy young adult. A T-score of -2.5 or below indicates osteoporosis; between -1 and -2.5 indicates osteopenia (low bone density). The FRAX tool calculates 10-year fracture risk based on clinical factors and bone density.
Management combines lifestyle measures (weight-bearing exercise, calcium and vitamin D adequacy, smoking cessation, fall prevention) with medication when indicated. Medications include bisphosphonates (first-line), denosumab, teriparatide, and others depending on fracture risk, tolerability and underlying causes. Regular monitoring ensures treatment remains appropriate.
| T-score / Risk | Classification | Recommended approach |
|---|---|---|
| T-score > -1.0 | Normal bone density | Lifestyle measures, calcium/vitamin D, address risk factors |
| T-score -1.0 to -2.5 | Osteopenia | FRAX assessment, lifestyle measures, consider medication if high risk |
| T-score ≤ -2.5 | Osteoporosis | Medication + lifestyle measures, fracture prevention |
| Fragility fracture | Osteoporosis (regardless of T-score) | Medication strongly recommended, falls prevention |