Osteoporosis

Osteoporosis is a metabolic bone disease that results in the disruption of the normal structure of the bone leading to consequential bone fragility and a higher predisposition to fractures. The diagnosis of osteoporosis is typically made using a dual-energy X-ray absorptiometry (DEXA) scan, also called a bone density scan. According to the World Health Organization, osteoporosis is defined as having a bone mineral density in the femur neck region, proximal femur, or lumbar spine that is at least 2.5 standard deviations below the average bone mineral density of a young adult female. This criterion should only be applied to postmenopausal women and men older than 50 years old. A clinical diagnosis of osteoporosis can also be made if an individual’s 10-year probability of a major osteoporotic fracture (meaning a fracture of the spine, hip, shoulder, or forearm) is at least 20% or the 10-year probability of a hip fracture is at least 3%. When patients are diagnosed with osteoporosis, the initial evaluation should include laboratory testing depending on the patient’s history and concern for secondary causes of osteoporosis. All patients with osteoporosis should be counseled on lifestyle modification including smoking cessation, limiting alcohol intake, and completing regular weight-bearing exercise. Bisphosphonates are typically the first-line therapy for postmenopausal female patients with osteoporosis and oral bisphosphonates are preferred to IV bisphosphonates from a cost-effectiveness perspective when they can be tolerated.