---
title: Osteoporosis Screening and Prevention
description: A comprehensive clinical reference on the screening, diagnosis, and prevention of osteoporosis.
keywords: [osteoporosis, bone density, fracture risk, DEXA scan, calcium, vitamin D]
category: clinical
---

## Osteoporosis Overview

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. It is a major public health concern, affecting millions of individuals worldwide and contributing to significant morbidity, mortality, and healthcare costs. Early detection and appropriate management of osteoporosis are crucial to reduce the burden of osteoporotic fractures.

## Screening and Diagnostic Criteria

The gold standard for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) scan. The World Health Organization (WHO) has established the following diagnostic criteria based on T-scores:

- Normal: T-score ≥ -1.0
- Osteopenia: T-score between -1.0 and -2.5
- Osteoporosis: T-score ≤ -2.5
- Severe Osteoporosis: T-score ≤ -2.5 with one or more fragility fractures

In addition to BMD, the Fracture Risk Assessment Tool (FRAX) can be used to estimate the 10-year probability of a major osteoporotic fracture (hip, spine, forearm, or humerus) and the 10-year probability of a hip fracture. The FRAX algorithm incorporates clinical risk factors, such as age, sex, body mass index (BMI), prior fracture history, parental history of hip fracture, and the use of glucocorticoids.

## Risk Factors and Prevention

The primary risk factors for osteoporosis include:
- Advancing age
- Female sex
- Caucasian or Asian ethnicity
- Family history of osteoporosis
- Low body weight (BMI < 20 kg/m²)
- Prolonged glucocorticoid use
- Excessive alcohol intake
- Cigarette smoking
- Sedentary lifestyle
- Vitamin D and calcium deficiency

Preventive strategies for osteoporosis include:

1. Lifestyle modifications:
   - Adequate dietary intake of calcium (1,000-1,200 mg/day for adults, 1,300 mg/day for adolescents)
   - Sufficient vitamin D intake (600-800 IU/day for adults, 600-1,000 IU/day for older adults)
   - Regular weight-bearing and muscle-strengthening exercises
   - Avoidance of excessive alcohol consumption and smoking

2. Pharmacological interventions:
   - Bisphosphonates (e.g., alendronate 70 mg weekly, risedronate 35 mg weekly, zoledronic acid 5 mg annually)
   - Denosumab 60 mg subcutaneously every 6 months
   - Selective estrogen receptor modulators (SERMs) (e.g., raloxifene 60 mg daily)
   - Teriparatide 20 mcg subcutaneously daily
   - Abaloparatide 80 mcg subcutaneously daily

The choice of pharmacological agent should be based on individual patient characteristics, risk factors, and shared decision-making between the healthcare provider and the patient.

## Treatment Recommendations

The American College of Physicians (ACP) and the National Osteoporosis Foundation (NOF) have published guidelines for the treatment of osteoporosis:

1. Pharmacological treatment is recommended for:
   - Individuals with a T-score ≤ -2.5 at the femoral neck, total hip, or lumbar spine
   - Individuals with a history of hip or vertebral fracture, regardless of BMD
   - Individuals with a 10-year major osteoporotic fracture risk ≥ 20% or a 10-year hip fracture risk ≥ 3% based on FRAX

2. Calcium and vitamin D supplementation:
   - Calcium: 1,000-1,200 mg/day for adults, 1,300 mg/day for adolescents
   - Vitamin D: 600-800 IU/day for adults, 600-1,000 IU/day for older adults

3. Monitoring and follow-up:
   - Repeat DXA scan every 1-2 years to assess response to treatment and monitor for changes in BMD
   - Monitor for adverse effects of pharmacological agents, such as atypical femoral fractures, osteonecrosis of the jaw, and esophageal irritation

## Contraindications and Adverse Effects

Contraindications to osteoporosis medications may include:

- Bisphosphonates: Severe renal impairment (creatinine clearance < 30 mL/min), hypocalcemia, esophageal abnormalities
- Denosumab: Hypocalcemia, severe renal impairment (creatinine clearance < 30 mL/min)
- SERMs: Pregnancy, history of venous thromboembolism, severe liver disease
- Teriparatide and abaloparatide: Paget's disease of bone, unexplained elevation of alkaline phosphatase, prior radiation therapy to the skeleton

Common adverse effects of osteoporosis medications include:

- Bisphosphonates: Gastrointestinal (GI) irritation, musculoskeletal pain, atypical femoral fractures, osteonecrosis of the jaw
- Denosumab: Hypocalcemia, infections, dermatologic reactions
- SERMs: Venous thromboembolism, hot flashes, leg cramps
- Teriparatide and abaloparatide: Nausea, dizziness, headache, hypercalcemia

Patients should be monitored closely for the development of these adverse effects, and appropriate management strategies should be implemented.

## Conclusion

Osteoporosis is a significant public health concern, and early detection and appropriate management are crucial to reduce the burden of osteoporotic fractures. Healthcare providers should be familiar with the screening, diagnostic criteria, risk factors, and evidence-based preventive and treatment strategies for osteoporosis. Comprehensive patient education and shared decision-making are essential to ensure optimal outcomes and adherence to the recommended interventions.