Osteoporosis Essentials

Key facts for patients & families — diagnosis, risk, medication, and daily care.

Evidence-based One-page A4 Patient handout

Definition & Diagnosis

  • T-score ≤ -2.5 (DXA) → Osteoporosis; between -1.0 and -2.5 → Osteopenia.
  • Fragility fracture = osteoporosis regardless of T-score.
  • Risk tools: FRAX / K-FRAX for 10-year hip & major fracture risk.

Who to screen

  • Women ≥ 65, men ≥ 70.
  • Postmenopausal women/men ≥ 50 with risk factors (long-term steroids, low BMI, prior fracture, smoking, alcohol).

Medications (overview)

Antiresorptives

  • Oral bisphosphonates: alendronate, risedronate (weekly) — avoid in severe GERD/CKD stage 4.
  • IV zoledronic acid (yearly) — check creatinine clearance.
  • Denosumab (q6m SC) — ensure calcium/vitamin D; plan exit strategy to prevent rebound.

Anabolics

  • Teriparatide/abaloparatide (daily SC, limited duration) for very high risk or multiple vertebral fractures.
  • Romosozumab (monthly, 12 months) — avoid in recent MI/stroke.

Reassess fracture risk every 1–2 years; consider drug holiday after stable bisphosphonate use.

Daily Management

  • Calcium 1,000–1,200 mg/day (diet first), Vitamin D 800–1,000 IU/day.
  • Weight-bearing + resistance exercise 3–5x/week; balance training to prevent falls.
  • Stop smoking; limit alcohol (≤ 2 drinks/day).
  • Home safety: lights, non-slip mats, assistive devices as needed.
Fall prevention matters as much as medication.

Vertebral Fracture Tips

  • Acute back pain after minor stress → consider compression fracture; get spine X-ray/MRI if red flags.
  • Early mobilization with brace and analgesia; avoid prolonged bed rest.
  • Initiate osteoporosis therapy promptly to prevent subsequent fractures.

Red Flags & When to Refer

  • Neurologic deficit, bowel/bladder symptoms, progressive height loss with severe pain.
  • Secondary causes: hyperparathyroidism, myeloma, malabsorption — screen if atypical.
  • High FRAX risk or multiple fractures → refer to specialist for anabolic/sequence therapy.