Osteoporose

Osteoporose, commonly known as osteoporosis, is a systemic skeletal disorder characterized by reduced bone strength that increases the risk of fracture. Bone strength reflects both bone mineral density and bone quality. In osteoporose, diminished bone mass and deterioration of bone tissue lead to fragility fractures, most often in the spine, hip, and wrist.

Most cases are primary osteoporosis, including type I (postmenopausal estrogen deficiency) and type II (senile age-related). Secondary osteoporosis results from medications and diseases such as long-term glucocorticoid use, endocrine disorders, malnutrition, and certain systemic illnesses.

Risk factors include advanced age, female sex, low body mass, family history, smoking, heavy alcohol use, low calcium and vitamin D intake, and physical inactivity. Diagnosis is based on bone mineral density measured by dual-energy X-ray absorptiometry (DXA). A T-score of -2.5 or lower at the hip or spine defines osteoporosis; -1.0 to -2.5 is osteopenia. The FRAX tool estimates 10-year fracture probability and guides treatment decisions.

Management combines lifestyle measures, optimization of calcium and vitamin D status, fall prevention, and pharmacotherapy for those at high risk or with fractures. Pharmacologic options include bisphosphonates (eg, alendronate, risedronate), denosumab, selective estrogen receptor modulators, and, in some cases, anabolic agents such as teriparatide or romosozumab. Therapy is tailored to the patient and may require monitoring with follow-up DXA scans.

Prevention emphasizes regular weight-bearing and resistance exercise, adequate nutrition, and avoidance of tobacco and excessive alcohol. Untreated osteoporosis increases the risk of fractures, which can lead to disability and reduced life expectancy, particularly after hip fracture.