Osteoporosis: Diagnosis, Treatment, and Fracture Prevention
Osteoporosis is a systemic metabolic skeletal disease characterized by decreased bone density and disruption of bone microarchitecture. Bones become brittle and fracture with minimal trauma—a fall from standing height, a sudden cough, or even a twist.
Osteoporosis-related fractures are more than just "accidental falls." They are a medical problem: a hip fracture leads to death within the first year in 20–30% of elderly patients and permanent loss of independence in most survivors. Osteoporosis, meanwhile, can persist for years without symptoms—it's been called a "silent epidemic."
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Osteoporosis Diagnosis
FRAX — calculation of 10-year fracture risk
FRAX (Fracture Risk Assessment Tool) is a standardized WHO algorithm recommended as the first step in diagnosis. It calculates the probability of an osteoporotic fracture in the next 10 years based on 12 clinical factors (age, gender, BMI, heredity, smoking, corticosteroids, secondary osteoporosis, alcohol, etc.) — with or without densitometry data.
The FRAX intervention threshold is a guideline for deciding whether to prescribe drug therapy.
DXA — densitometry
Dual-energy X-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. Measures bone mineral density (BMD) in the lumbar spine and proximal femur.
The result is assessed by the T-score:
| T-score | Conclusion |
|---|---|
| Above -1.0 SD | Normal |
| From -1.0 to -2.5 SD | Osteopenia |
| -2.5 SD and | Osteoporosis |
| -2.5 SD and below + fracture | Severe osteoporosis |
DXA is indicated:
- Women aged 65 and over and men aged 70 and over
- Menopausal women and men aged 50–69 with risk factors
- With long-term GCS treatment (>3 months)
- With verified or suspected pathological fractures
- With secondary osteoporosis (after treatment of hyperthyroidism, hyperparathyroidism, etc.)
Laboratory examination
- Total and ionized calcium, phosphorus
- Vitamin D (25-OH-D) — essential; deficiency (<20 ng/ml) is extremely common and directly impacts the effectiveness of anti-osteoporotic treatment.
- Parathyroid hormone (PTH)
- Bone remodeling markers: β-CrossLaps (resorption marker), P1NP (formation marker) — to monitor therapy effectiveness.
- TSH, testosterone in men, sex hormones in women — to rule out secondary osteoporosis.
Osteoporosis treatment
Non-drug basis (mandatory for everyone)
- Vitamin D: target 25-OH-D level ≥ 30 ng/mL; in case of deficiency, therapeutic doses of 3000–5000 IU/day
- Calcium: 1000–1200 mg/day combined from food and supplements
- Physical activity: bodyweight exercises, strength training, and balance training (to reduce the risk of falls)
- Quitting smoking and minimizing alcohol
- Fall prevention: vision correction, creating a safe home environment, discontinuing medications that increase the risk of falls
Frequently Asked Questions (FAQ)
Is osteoporosis a "calcium deficiency"?
Not quite. Calcium deficiency is one factor, but osteoporosis is a systemic disease with an imbalance between bone formation and breakdown. Calcium supplementation alone without assessing BMD, FRAX, and background therapy is insufficient.
How often should DXA be done?
With normal BMD and no risk factors, every 5 years. With osteopenia or during treatment, every 2 years. With severe osteoporosis or a change in therapy, at the doctor's discretion.
Is it possible to play sports if you have osteoporosis?
Yes—and you should. Body-weight-bearing exercises (walking, dancing, physical therapy) and moderate-intensity strength training reduce the risk of falls and fractures. Swimming and cycling are good for the heart but put less stress on bones.
Should I take calcium separately from bisphosphonates?
Bisphosphonates are taken on an empty stomach, while calcium is taken with food, between bisphosphonate doses. Concomitant use is not recommended, as calcium reduces the absorption of bisphosphonates.
Denosumab – forever?
No. After discontinuing denosumab, a rebound acceleration of bone resorption occurs, which can lead to vertebral fractures. Therefore, discontinuing denosumab requires a mandatory switch to bisphosphonates under physician supervision.
Can a man get osteoporosis?
Yes. About 30% of all osteoporotic fractures occur in men. The risk is higher with hypogonadism, long-term use of corticosteroids, alcoholism, and chronic gastrointestinal diseases.
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Who is at risk?
Risk factors beyond our control:
Controllable risk factors:
Secondary osteoporosis develops as a consequence of other diseases: