Osteoporosis

Women typically build bone until around age 30, after which gradual bone loss occurs, accelerating further with menopause. Osteoporosis, a disease that weakens bones and predisposes individuals to fractures, often goes undiagnosed until a fracture occurs.  This disease leads to two million fractures annually in the US alone.

Osteoporosis is initially painless and asymptomatic, but without treatment, it becomes debilitating and painful, especially in menopausal patients. In fact, it’s the leading cause of morbidity in this demographic. The risk of hip fracture due to osteoporosis equals the combined risk of breast, uterine, and ovarian cancer in women. Over a quarter of women with a hip fracture die within 12 months. However, osteoporosis is preventable and treatable.

Prevention strategies include weight-bearing exercise, calcium and magnesium supplementation, vitamin D intake, smoking cessation, minimal alcohol consumption, and hormone replacement therapy (HRT). Screening for osteoporosis typically begins at age 65 but may start earlier for individuals with risk factors such as being underweight, steroid use, rheumatoid arthritis, postmenopausal status, family history, smoking, height loss, and sedentary lifestyle. Screening involves calculating a FRAX score and bone density radiologic tests.

Treatments for osteoporosis include bisphosphonates, intravenous medications, selective estrogen receptor modulators like raloxifene, and hormone replacement therapy, among others. Bisphosphonates are usually well-tolerated and taken for about five years before reevaluation. Bone mineral densitometry, a painless test with minimal radiation exposure, determines if medication is necessary based on bone health.