Osteoporosis

Abstract

Osteoporosis is defined by the WHO as bone densitometry derived T-scores being ≤2.5 at the lumbar spine or the hip. Osteoporosis should be ascertained by DXA in individuals with a risk factor of osteoporosis including a history of fracture, low body weight, parental history of hip fracture, use of glucocorticoids, in conditions with bone adverse effects (hypogonadism, hyperthyroidism, hyperparathyroidism, chronic inflammatory diseases, hypopituitarism, use of Gonadotropin-releasing hormon (GnRH) agonists and aromatase inhibitors), and in older patients at high risk of falling. Osteoporosis drugs should be considered after a careful assessment of the benefit/risk ratio in patients at high risk of fracture, i.e., with a fragility fracture or a densitometry confirmed osteoporosis. Oral bisphosphonates are initial agents in older people. Subcutaneous denosumab, teriparatide, or intravenous zoledronic acid may be considered as second-line therapy.