Asymptomatic until fracture occurs.
Diagnosis based on history of prior fragility fracture or low bone mineral density, which is defined as a T-score ≤-2.5.
Screening is based on individual risk factors, including female sex, maternal history of fragility fracture/osteoporosis, older age, low body mass index (<20-25 kg/m²), body weight <58 kg, weight loss of >10% of body weight, androgen deprivation treatment (in males), aromatase inhibitor treatment (in females), corticosteroid use, tobacco use, and kidney stone disease.
Fall prevention is first-line therapy.
Bisphosphonates are first-line pharmacologic therapy for postmenopausal women and men.
In postmenopausal women, estrogen is considered only for those at high risk for whom nonestrogen medications are inappropriate.
Osteoporosis is a complex skeletal disease characterized by low bone density and microarchitectural defects in bone tissue, resulting in increased bone fragility and susceptibility to fracture.
History and exam
Other diagnostic factors
- back pain
- impaired vision
- impaired gait, imbalance, and lower-extremity weakness
- vertebral tenderness
- prior fragility fracture
- female sex
- white ancestry
- older age (>50 years for women and >65 years for men)
- low BMI
- loss of height
- family history of maternal hip fracture
- secondary amenorrhea
- primary hypogonadism
- tobacco use
- excessive alcohol use
- prolonged immobilization
- low calcium intake
- vitamin D deficiency
- glucocorticoid excess
- corticosteroid use
- proton-pump inhibitors
- heparin use
- anticonvulsant use
- weight loss >10% body weight
- androgen deprivation treatment (men)
- aromatase inhibitor treatment (women)
1st investigations to order
- dual-energy x-ray absorptiometry (DXA)
Investigations to consider
- Fracture Risk Assessment Tool (FRAX)
- quantitative ultrasound (QUS) of the heel
- x-ray (wrist, heel, spine, and hip)
- quantitative CT
- biochemical markers of bone resorption and bone formation
- serum alkaline phosphatase
- serum calcium
- serum albumin
- serum creatinine
- serum phosphate
- serum 25-hydroxy vitamin D
- serum parathyroid hormone
- thyroid function tests
- urinary free cortisol
- serum testosterone (men)
- urine protein electrophoresis
- serum protein electrophoresis
not glucocorticoid-induced: women
not glucocorticoid-induced: men
- Multiple myeloma
- Chronic kidney disease-bone and mineral disorder
- Pharmacological management of osteoporosis in postmenopausal women
- Screening for osteoporosis to prevent fractures
Osteoporosis: what is it?
Osteoporosis: what treatments work?More Patient leaflets
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