Osteoporosis
Osteoporosis is defined by a DEXA T-score of −2.5 or lower at the spine, femoral neck, or total hip. It substantially increases fracture risk, with hip fractures carrying a 20 -- 30% mortality rate in the first year. Treatment reduces fracture risk by 30 -- 70% depending on the site and medication, making early identification and treatment critically important.
Symptoms
Osteoporosis is asymptomatic until a fracture occurs. Classic presentations include acute back pain from a vertebral compression fracture after minimal trauma, wrist fracture from a fall, or hip fracture. Height loss and thoracic kyphosis develop with multiple vertebral fractures.
Causes and risk
Postmenopausal estrogen deficiency is the primary driver in women. Male hypogonadism, corticosteroid use (most common secondary cause), hyperparathyroidism, hyperthyroidism, celiac disease, inflammatory bowel disease, chronic kidney disease, and multiple myeloma are important secondary causes to exclude.
How it is evaluated
DEXA scan establishes diagnosis. FRAX fracture risk calculation guides treatment decisions. Lab evaluation includes calcium, phosphorus, 25-OH-D, PTH, complete metabolic panel, CBC, TSH, testosterone (men), and protein electrophoresis when myeloma is suspected. Vertebral fracture assessment (VFA) identifies asymptomatic spine fractures.
Treatment
Oral bisphosphonates (alendronate, risedronate) are first-line for most patients. IV zoledronic acid is preferred for GI intolerance or adherence concerns. Denosumab is used for severe cases or as an alternative. Teriparatide or abaloparatide (anabolic agents) are reserved for very high fracture risk. All patients receive calcium and vitamin D management.