Osteoporosis

Osteoporosis is a condition marked by weakened, fragile bones that are more susceptible to fractures. This occurs when the breakdown of bone tissue happens faster than the formation of new bone, resulting in decreased bone density and strength. Often progressing without symptoms, osteoporosis becomes apparent after a fracture, typically affecting areas such as the hip, wrist, or spine. It is particularly prevalent among older adults and postmenopausal women due to hormonal changes that impact bone density. Early detection and management are vital to prevent fractures and maintain bone health.

Diagnosis

Osteoporosis is often a silent condition, presenting no symptoms until a fracture occurs, making early screening essential. The primary diagnostic tool is a bone mineral density (BMD) test conducted via a dual-energy X-ray absorptiometry (DEXA) scan. This noninvasive, painless scan provides a T-score that assesses bone density: a score of -1.0 or higher is normal, between -1.0 and -2.5 indicates osteopenia, and -2.5 or lower is indicative of osteoporosis. While guidelines suggest BMD testing for all women over 65 and postmenopausal women with risk factors, there is less defined guidance for men due to lower prevalence rates. Osteoporosis may also be diagnosed following fractures, even if the T-score does not meet typical criteria. The Fracture Risk Assessment Tool (FRAX) is also used to predict fracture risk over the next decade. If an individual with osteopenia has a high fracture risk according to FRAX, they might be classified as having osteoporosis.

Treatments

The primary goal in managing osteoporosis is to reduce the risk of fractures, which commonly affect the spine, hip, and wrist. Fractures can cause pain and significant challenges such as disability, difficulty in daily activities, and increased reliance on others for care and mobility. Beyond medication, fall prevention is critical in osteoporosis management. Falls, the main cause of fractures in those with osteoporosis, must be avoided by addressing various risks such as home hazards, poor balance, muscle weakness, vision problems, alcohol consumption, and dizziness-inducing medications. Preventive measures include wearing prescribed glasses and hearing aids, removing or securing loose wires, rugs, and pet items, keeping floors and stairs clutter-free, ensuring adequate lighting, seeking assistance for reaching tasks, and installing handrails in critical areas like bathrooms and stairways. If you feel discouraged by needing assistance or fear falling, discuss these concerns with your healthcare provider.

Medications

• Medical guidelines from authoritative organizations recommend treating osteoporosis in postmenopausal women and men over 50 if they have experienced a hip or spine fracture, have a T-score worse than -2.5, or have a T-score between -1.0 and -2.5 with a high 10-year FRAX fracture probability.

• Medications to manage osteoporosis primarily aim to slow bone resorption. They can be taken orally, by injection, or via an IV. Examples include:

• Alendronate (Fosamax)

• Alendronate plus D

• Ibandronate (Boniva)

• Risedronate (Actonel, Atelvia)

• Zoledronic acid (Reclast)

• Calcitonin (Miacalcin, Fortical)

• Raloxifene (Evista)

• Denosumab (Prolia)

• Other medications promote new bone formation and are typically administered as injections, such as:

• Teriparatide (Forteo)

• Abaloparatide (Tymlos)

• Romosozumab (Evenity)