What is Osteoporosis?

Osteoporosis is a condition where bones become weak and brittle, increasing the risk of fractures, especially in the hips, spine, and wrists.

Symptoms:

• Often called a "silent disease" because there are no symptoms until a fracture occurs, but some warning signs may include:
• Back pain (due to fractured or collapsed vertebra)
• Loss of height over time
• Stooped posture (kyphosis)
• Easy bone fractures (e.g., from a minor fall)

Investigations:

• 1- DEXA Scan (Dual-Energy X-ray Absorptiometry)
• Gold standard test to measure bone mineral density (BMD)
• T-score interpretation:
• Normal: ≥ –1.0
• Osteopenia: –1.0 to –2.5
• Osteoporosis: ≤ –2.5
• 2- FRAX Score
• Tool to calculate 10-year fracture risk based on risk factors ± BMD.
• 3- Blood tests (to rule out secondary causes):
• Calcium, phosphate, Vitamin D
• Thyroid function
• Parathyroid hormone (PTH)
• Serum protein electrophoresis (to rule out myeloma)
• Renal and liver function

Treatment & Management:

• Lifestyle Measures (First line for all)
• Weight-bearing and resistance exercises
• Calcium-rich diet (1,000–1,200 mg/day)
• Vitamin D supplementation (800 IU/day)
• Stop smoking & reduce alcohol
• Pharmacological Treatment

Initiate if:

• T-score ≤ –2.5
• Fragility fracture
• High fracture risk per FRAX

1. First-line: 

• • Bisphosphonates
  • Alendronate (weekly oral)
  • Risedronate
  • Zoledronic acid (annual IV)

2. Alternatives:

• • Denosumab (SC every 6 months)
  • Raloxifene (selective oestrogen receptor modulator)
  • Teriparatide (recombinant PTH, for severe cases)

Follow-up:

• Reassess BMD every 2–5 years (based on risk factors)
• Monitor adherence and side effects of treatment
• Check calcium and Vitamin D levels annually

References:

NICE Guideline NG 226: Osteoporosis: assessing the risk of fragility fracture (2022)

National Osteoporosis Foundation

SIGN Guideline 142: Management of Osteoporosis (2020)

Dr Geranmayeh