Osteoporosis is a common disease that is characterised by low bone mass, micro architectural disruption, and skeletal fragility, resulting in an increased risk of fracture. The burden of suffering associated with osteoporosis is related to the increased incidence of fractures in individuals with low bone mass and micro architectural deterioration. Fragility fractures are defined as fractures that occur following a fall from standing height or less or with no trauma. Osteoporosis has no clinical manifestations until there is a fracture. Complications of fractures include pain, deformity, disability, and loss of height.

Risk factors include the following

  • Advanced age
  • Previous fracture
  • Long-term glucocorticoid therapy
  • Low body weight (less than 58 kg)
  • Family history of hip fracture
  • Cigarette smoking
  • Excess alcohol intake

Lifestyle measures should be adopted universally to reduce bone loss in postmenopausal women. Lifestyle measures include adequate calcium and vitamin D, exercise, smoking cessation, counseling on fall prevention, and avoidance of heavy alcohol use. Many patients require vitamin D supplementation as it is difficult to achieve goals with diet alone.  In addition to nonpharmacologic therapy, I recommend that patients with severe and established osteoporosis (T-score ≤-2.5) or fragility fracture be carefully assessed regarding treatment with a pharmacologic agent.

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