Osteoporosis

A Fractured Framework

Osteoporosis is a skeletal disorder defined by reduced bone strength, which dramatically increases the risk of fractures. Bone strength hinges on two key factors: bone density and quality. The World Health Organization (WHO) sets the standard for osteoporosis diagnosis as a bone mineral density (BMD) 2.5 standard deviations below the average of young healthy women. This measurement, often obtained through a dual-energy X-ray absorptiometry (DXA) scan, is the gold standard for assessing bone health.

Osteoporosis operates largely in silence. Most patients don’t experience symptoms until a fracture occurs, often in the hip, spine, or wrist. Fractures can happen spontaneously or with minimal trauma, causing acute pain, height loss, and even spinal deformities. Once a fracture occurs, it often signals the beginning of a cascade—patients with an initial fracture have a much higher risk of future breaks, dramatically reducing quality of life and increasing mortality, especially in the elderly.

DXA (dual energy x-ray absorptiometry) is the imaging test used to measure bone mineral density.

The mechanics behind osteoporosis lie in an imbalance between bone resorption and formation. As we age, bone breakdown (led by osteoclasts) surpasses the body’s ability to form new bone (a job for osteoblasts), leading to a net loss of bone mass. This imbalance is especially pronounced in postmenopausal women, where decreased estrogen levels accelerate bone loss. Other contributing factors include chronic inflammation, long-term use of glucocorticoids, chronic illnesses that limit physical activity, and oxidative stress.

The prevalence of osteoporosis in the United States is staggering: approximately 10.2 million people over 50 have the disease, and an additional 43 million are at risk due to low bone mass. Women, especially postmenopausal, are disproportionately affected, with as many as half of white women over the age of 60 either having osteoporosis or its precursor, osteopenia. Men are not immune, though their rates are lower. Racial and ethnic disparities also exist, with non-Hispanic white women experiencing the highest rates, followed by Hispanic and Asian women, and African American women showing the lowest prevalence.

Screening and Diagnosis

Given its stealthy nature, early detection of osteoporosis is crucial. The gold standard for diagnosing osteoporosis is the DXA scan, which provides a T-score that reflects how your BMD compares to that of a young, healthy adult. A T-score of -2.5 or lower signals osteoporosis, while a score between -1.0 and -2.5 indicates osteopenia. In addition to the T-score, physicians may use the FRAX tool (check this link), which estimates a patient’s 10-year probability of fracture based on clinical risk factors and BMD. Screening is recommended for all women over 65 and men over 70, and for younger individuals with risk factors such as a previous fracture or long-term steroid use.

FRAX calculator is commonly used to estimate the 10-year probability of hip and other osteoporosis-related fractures (https://frax.shef.ac.uk/FRAX/tool.aspx?country=9)

Treatment and Prevention

Treating osteoporosis is a multi-faceted approach, combining lifestyle changes and medications to both strengthen bones and prevent fractures. The first line of defense often involves bisphosphonates, which slow bone resorption and reduce fracture risk. Other treatments include denosumab, an antibody that blocks bone breakdown, and anabolic agents like teriparatide and romosozumab, which stimulate new bone formation. Treatment may also involve a sequence of therapies, starting with bone-building medications and transitioning to drugs that prevent further breakdown.

Prevention plays an equally important role. Adequate intake of calcium and vitamin D is essential for maintaining bone health, along with weight-bearing exercise like walking or resistance training, which helps build and maintain bone density. Lifestyle modifications, such as quitting smoking and limiting alcohol, further help reduce bone loss. Fall prevention is also key for older adults, and may include home safety assessments and physical therapy to improve balance and mobility.

How Dr. Hasan Can Help

At Chia Endocrinology & Wellness, Dr. Hasan provides expert care to both prevent and manage osteoporosis. Using advanced diagnostic tools like the DXA scan, Dr. Hasan identifies at-risk patients early, well before fractures occur. His treatment plans are tailored to individual needs, combining lifestyle guidance with medications to both halt bone loss and, when possible, stimulate new bone growth. Whether preventing the onset of osteoporosis or managing its progression, Dr. Hasan helps his patients maintain strong bones and reduce the risk of life-altering fractures.