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
- 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)
- 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
Khashayar Sakhaee, MD
Professor in Internal Medicine
Division Chief of Mineral Metabolism
Center for Mineral Metabolism and Clinical Research
UT Southwestern Medical Center at Dallas
KS declares that he has no competing interests.
Alberto V Cabo Chan Jr., MD
University of Texas Southwestern
AVCC declares that he has no competing interests.
Dr Khashayar Sakhaee and Dr Alberto V Cabo Chan Jr. would like to gratefully acknowledge Dr Lisa Leinau, a previous contributor to this topic.
LL declares that she has no competing interests.
Kimberly Olson, MD
Veterans Administration Hospital
KO declares that she has no competing interests.
David Reid, MBBS
Head of Division of Applied Medicine & Professor of Rheumatology
School of Medicine & Dentistry
University of Aberdeen
DMR has attended meetings sponsored by or been paid speaker fees by Amgen, Merck, Novartis, Procter & Gamble, Roche, and Servier. He has been a paid advisor to Amgen, Merck, Novartis, Procter & Gamble, Roche, Servier, and Shire Pharmaceuticals. He has undertaken research studies funded by Amgen, Merck, Novartis, Procter & Gamble, and Roche.
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