[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Osteoporosis [Conditions](https://durgical.com/en/conditions/) · [Systemic conditions](https://durgical.com/en/conditions/) # Osteoporosis Osteoporosis is a disease of thin, weak bones that break with minor falls or knocks, typically in the hip, spine and wrist. Updated 2026-10-30 ## Structures involved Tap one to see what it is and open it in 3D. - [T12 vertebra](https://durgical.com/en/anatomy/t12/) - [L1 vertebra](https://durgical.com/en/anatomy/lumbar-vertebra/) - [Femur](https://durgical.com/en/anatomy/femur/) - [Radius](https://durgical.com/en/anatomy/radius/) - [T11 vertebra](https://durgical.com/en/anatomy/t11/) - [L2 vertebra](https://durgical.com/en/anatomy/lumbar-vertebra-spine-and-pelvis/) - [Endplates](https://durgical.com/en/anatomy/vertebral-endplates/) - [Humerus](https://durgical.com/en/anatomy/humerus/) - [Hip bone](https://durgical.com/en/anatomy/hip-bone/) ## In biochemistry - [Collagen](https://durgical.com/en/biochemistry/enzymes/collagen/) - [Vitamin D (calcitriol)](https://durgical.com/en/biochemistry/molecules/vitamin-d/) - [Calcium and phosphate](https://durgical.com/en/biochemistry/topics/calcium-and-phosphate/) ## In histology - [Bone tissue: cells, compact and spongy bone](https://durgical.com/en/histology/bone-tissue-cells-compact-and-spongy-bone/) - [Ossification, growth plate and bone remodeling](https://durgical.com/en/histology/ossification-growth-plate-and-bone-remodeling/) ## In physiology - [Actions of cortisol](https://durgical.com/en/physiology/actions-of-cortisol/) - [Bone remodeling](https://durgical.com/en/physiology/bone-remodeling/) - [Aviation and space physiology](https://durgical.com/en/physiology/aviation-and-space-physiology/) - [Actions of estrogen and progesterone](https://durgical.com/en/physiology/actions-of-estrogen-and-progesterone/) - [Menopause](https://durgical.com/en/physiology/menopause/) ## Why it happens - [How organs age: normal changes vs disease](https://durgical.com/en/general-pathology/how-organs-age-normal-changes-vs-disease/) - [Cachexia, anorexia nervosa and bulimia](https://durgical.com/en/general-pathology/cachexia-anorexia-nervosa-and-bulimia/) - [Cellular aging: telomeres, DNA damage, senescence and proteostasis](https://durgical.com/en/general-pathology/cellular-aging-telomeres-dna-damage-senescence-and-proteostasis/) - [Heavy metals: lead, mercury, arsenic and cadmium](https://durgical.com/en/general-pathology/heavy-metals-lead-mercury-arsenic-and-cadmium/) ## What it is A skeletal disease of low bone mass and deteriorated bone microarchitecture that makes bones fragile, so they break with minimal trauma (fragility fractures), typically in the hip, spine and wrist. ## Who gets it Most common in postmenopausal women and older adults of both sexes. Population ageing in Colombia and Latin America is increasing hip and vertebral fractures; many cases are found only after a fracture. In Latin American studies, hip fracture rates after age 50 ranged from 53 to 443 per 100,000 in women and 27 to 135 per 100,000 in men. ## Causes - Primary: menopause-related oestrogen loss and ageing - Glucocorticoid treatment (the most common secondary cause) - Endocrine: hyperthyroidism, hyperparathyroidism, hypogonadism, diabetes, Cushing syndrome - Malabsorption (for example coeliac disease), chronic [kidney](https://durgical.com/en/anatomy/kidney/) or liver disease, rheumatoid arthritis - Drugs such as anticonvulsants, aromatase inhibitors and excess thyroid hormone ## Risk factors - Female sex, older age and early menopause - Previous fragility fracture and parental hip fracture - Low body weight - Smoking and excess alcohol - Low calcium and vitamin D intake, physical inactivity - Long-term glucocorticoids - Falls risk: poor balance, poor vision, sedatives ## Pathophysiology Bone is constantly remodelled by osteoclasts (resorption) and osteoblasts (formation). After menopause and with age, resorption exceeds formation; trabeculae thin and lose connections and cortical bone becomes porous. Trabecular-rich sites such as the vertebral bodies and the femoral neck and distal [radius](https://durgical.com/en/anatomy/radius/) fail first. ## Classification - Primary (postmenopausal or age-related) and secondary - By bone density (WHO, using T-score): normal, low bone mass (osteopenia, T-score between -1 and -2.5), osteoporosis (-2.5 or lower), severe osteoporosis (with a fragility fracture) ## Symptoms and signs - Silent until a fracture occurs - Sudden back pain after minor strain (vertebral compression fracture), though many vertebral fractures are painless - Loss of height and increased thoracic kyphosis - Hip fracture after a fall from standing height - Distal radius (wrist) fracture after falling on an outstretched hand ## Red flags - Vertebral fracture with neurological deficit, fever, weight loss or a history of cancer (consider malignancy or infection) - Fracture without trauma in a young person or a man (look for secondary causes) - Very low bone density with abnormal calcium or phosphate (osteomalacia, myeloma, hyperparathyroidism) ## Diagnosis **Clinical** A hip or vertebral fragility fracture establishes the diagnosis clinically. Clinicians estimate the 10-year fracture probability with FRAX, which combines clinical risk factors with or without bone density. **Tests** Calcium, phosphate, vitamin D, creatinine, [liver](https://durgical.com/en/anatomy/liver/) function, blood count and thyroid tests to exclude secondary causes; PTH, testosterone, coeliac serology or protein electrophoresis when suggested. Bone turnover markers in some settings. **Imaging** DXA of the lumbar [spine](https://durgical.com/en/anatomy/region/spine/) and hip is the standard: a T-score of -2.5 or lower defines osteoporosis in postmenopausal women and men aged 50 or over (Z-scores are used in younger people). Spine X-ray or vertebral fracture assessment finds silent fractures. ## Differential diagnosis - Osteomalacia (vitamin D deficiency) - Multiple myeloma and bone metastases - Primary hyperparathyroidism - Osteogenesis imperfecta - Renal osteodystrophy ## Goal of treatment Prevent first and further fractures by increasing bone strength and reducing falls, and treat pain and disability after fractures. ## Treatment **Lifestyle** Adequate calcium and vitamin D, weight-bearing and balance exercise, stopping smoking, limiting alcohol and home fall-prevention measures. **Medical** Antiresorptive agents (bisphosphonates, denosumab, selective oestrogen receptor modulators, hormone therapy in selected women) reduce bone loss. **Medical** Anabolic (bone-forming) agents for very high fracture risk, followed by an antiresorptive. **Surgical** Fixation or joint replacement for hip fractures; vertebral augmentation in selected painful vertebral fractures. **Follow-up** Repeat DXA at intervals set by guidelines, adherence checks and review of the need for continued therapy. ## Drugs for this condition - [Raloxifene](https://durgical.com/en/pharmacology/raloxifene/) ## Complications - Hip fracture with high mortality and loss of independence - Multiple vertebral fractures with chronic pain, kyphosis and reduced lung capacity - Distal radius and proximal [humerus](https://durgical.com/en/anatomy/humerus/) fractures - Rare effects of long-term antiresorptives: osteonecrosis of the jaw and atypical femoral fractures ## Prognosis Treatment reduces fracture risk substantially, yet many people at risk are never treated. One fragility fracture greatly raises the risk of another, especially in the following one to two years. ## Prevention - Peak bone mass in youth: calcium-rich diet and exercise - Avoiding smoking and excess alcohol - Screening with DXA in groups recommended by local guidelines - Fall prevention in older adults - Bone protection when long-term glucocorticoids are prescribed ## Test yourself Think of the answer, then tap the question to see it. ## What DXA T-score defines osteoporosis in postmenopausal women? A T-score of -2.5 or lower at the lumbar spine, femoral neck or total hip; between -1 and -2.5 is low bone mass (osteopenia). ## What are the three classic sites of osteoporotic fragility fracture? Hip (proximal femur), vertebral bodies (compression fractures) and distal radius (Colles fracture after a fall on the outstretched hand). ## What does the FRAX tool estimate? The 10-year probability of a major osteoporotic fracture and of a hip fracture, from clinical risk factors with or without femoral neck bone density. ## What is the most common cause of secondary osteoporosis? Long-term glucocorticoid therapy, which reduces bone formation and increases resorption; fracture risk rises within months. ## How do bisphosphonates work? They bind to bone mineral and inhibit osteoclasts, reducing bone resorption; they are antiresorptive agents. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/osteoporosis/) ## Related conditions - [Femoral Neck Fracture](https://durgical.com/en/conditions/femoral-neck-fracture/) - [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/) - [Primary hyperparathyroidism](https://durgical.com/en/conditions/primary-hyperparathyroidism/) - [Coeliac disease](https://durgical.com/en/conditions/coeliac-disease/) - [Cushing syndrome](https://durgical.com/en/conditions/cushing-syndrome/) - [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/) - [Pituitary adenoma](https://durgical.com/en/conditions/pituitary-adenoma/) - [Metatarsal fractures (including stress fractures)](https://durgical.com/en/conditions/metatarsal-fractures/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Osteoporosis in Females](https://www.ncbi.nlm.nih.gov/books/NBK559156/) (StatPearls (NCBI Bookshelf), 2025); [Consensus statement: osteoporosis prevention and treatment in Latin America-current structure and future directions](https://europepmc.org/article/PMC/PMC6132387) (Archives of osteoporosis, 2018) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). [← All conditions](https://durgical.com/en/conditions/) ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/conditions/osteoporosis/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/osteoporosis/