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Osteoporosis is a progressive condition that weakens bones and raises the risk of fractures. Because it often causes no pain until a fracture occurs, it is commonly described as a “silent” disease. Early identification of osteoporosis symptoms, timely testing with a bone density test, and specialist input from a rheumatology specialist make a substantial difference in preserving mobility, independence, and quality of life. This article explains who is at risk, how osteoporosis is diagnosed, practical steps for prevention, and current treatment options.
Synopsis
- Osteoporosis: The Silent Bone Disease
- Who is At Risk of Osteoporosis?
- Recognising Osteoporosis Symptoms
- Diagnosis: The Role of the Bone Density Test
- Evidence-Based Approaches to Treatment
- Prevention: Practical Measures that Work
- Monitoring and Follow-Up
- When to Refer to a Rheumatology Specialist
- Conclusion
Osteoporosis: The Silent Bone Disease
Osteoporosis is a skeletal disorder characterised by low bone mass and deterioration of bone microarchitecture. As bones lose density and strength, they become more prone to fractures from low-impact events, for example, a fall from standing height. Fractures of the hip, spine, and wrist are the most common and carry significant morbidity. Vertebral fractures can lead to loss of height, chronic pain, and reduced lung function. Hip fractures frequently require surgery and long rehabilitation, and they are associated with increased mortality in older adults.
Understanding the condition early allows clinicians to intervene before fractures occur. The goal is straightforward: retain bone strength, reduce fracture risk, and maintain daily function.
Who is At Risk of Osteoporosis?
Assessment is appropriate for the following groups:
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Postmenopausal women, particularly those aged 65 and older.
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Men aged 70 and older.
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Adults of any age with a history of fragility fracture (a fracture from minimal trauma).
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Long-term users of glucocorticoids or other medications that affect bone metabolism.
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Individuals with conditions linked to secondary osteoporosis (for example, rheumatoid arthritis, chronic kidney disease, untreated hypogonadism, and malabsorption syndromes).
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People with a family history of hip fracture or early osteoporosis.
A rheumatology specialist or primary physician can determine the need for testing based on risk factors and clinical assessment.
Recognising Osteoporosis Symptoms
Early osteoporosis often produces no symptoms. When signs appear, they may include:
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Sudden onset of back pain, sometimes with loss of height, is a sign of vertebral compression fracture.
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Recurrent fractures with minimal trauma.
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Stooped posture or progressive curvature of the spine.
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Unexplained height loss.
Because many of these signs are subtle, a proactive approach to screening is important. Relying solely on symptoms can delay diagnosis until after a fracture has occurred.
Diagnosis: The Role of the Bone Density Test
The standard diagnostic tool is the bone density test, commonly performed using dual-energy X-ray absorptiometry (DEXA or DXA). This painless scan measures bone mineral density at the hip and spine and compares results to young adult reference values, producing a T-score.
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Normal: T-score ≥ −1.0
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Osteopenia (low bone mass): T-score between −1.0 and −2.5
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Osteoporosis: T-score <-2.5
In addition to DEXA, clinicians use clinical risk calculators that factor age, prior fractures, steroid use, smoking, alcohol intake, and family history to estimate 10-year fracture risk. Blood tests and, occasionally, additional imaging help exclude secondary causes and guide treatment.
Evidence-Based Approaches to Treatment
Treatment aims to reduce fracture risk and optimise bone quality. Options include lifestyle measures, supplements, and prescription medicines. Selection depends on fracture risk, comorbidities, and patient preferences.
Lifestyle and nutritional measures:
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Adequate calcium intake, from a diet or supplements when necessary.
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Sufficient vitamin D to support calcium absorption; supplementation is common in individuals with low levels or limited sun exposure.
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Regular weight-bearing and muscle-strengthening exercise to maintain bone and balance.
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Smoking cessation and moderation of alcohol intake.
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Fall risk assessment and home safety measures to reduce the likelihood of fractures.
Pharmacologic therapies:
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Bisphosphonates (oral or intravenous) are first-line agents for many patients; they reduce vertebral and hip fractures.
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Denosumab, a monoclonal antibody administered by injection, lowers fracture risk, particularly in those who cannot tolerate bisphosphonates.
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Anabolic agents (for example, teriparatide) stimulate new bone formation and are used for severe osteoporosis or when other therapies fail.
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Selective estrogen receptor modulators and hormone replacement therapy may be appropriate in selected postmenopausal patients after risk–benefit assessment.
Treatment duration and monitoring are tailored to individual response and evolving fracture risk. Periodic bone density tests guide long-term management.
Prevention: Practical Measures that Work
Preventive strategies reduce the likelihood of developing osteoporosis and fractures:
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Diet |
Maintain a balanced diet with adequate calcium (dairy, leafy greens, fortified foods) and vitamin D. |
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Physical Activity |
Engage in regular physical activity that includes walking, stair climbing, resistance training, and balance exercises. |
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Medications |
Review medications with a clinician to identify agents that may increase fracture risk; consider alternatives when possible. |
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Underlying Issues |
Address chronic conditions that impair bone health with appropriate medical care. |
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Fall-Prevention |
Implement fall-prevention measures at home: secure rugs, install handrails, ensure adequate lighting, and review vision and footwear. |
Prevention is a continuous process and should begin in mid-life or earlier in people with risk factors.
Monitoring and Follow-Up
After starting treatment, follow-up includes clinical review, repeat bone density tests at intervals (often every 1–3 years), and reassessment of fracture risk. Blood tests may monitor calcium and vitamin D status and examine for secondary causes. Therapy adjustments follow changes in risk profile or side effects. Long-term plans balance fracture prevention with safety and patient goals.
When to Refer to a Rheumatology Specialist
Referral to a rheumatology specialist is appropriate when:
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Osteoporosis occurs in younger adults or with minimal expected risk factors.
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Multiple fractures occur despite treatment.
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Secondary causes of bone loss are suspected and require specialist evaluation.
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Complex treatment decisions are needed, such as the use of anabolic agents or the management of treatment intolerance.
Specialist input ensures a thorough diagnostic workup and access to advanced therapies.
Conclusion
Osteoporosis is common, preventable often, and treatable when identified. A proactive approach, recognising osteoporosis symptoms, obtaining a bone density test when indicated, and involving a rheumatology specialist for complex cases, reduces fracture risk and helps maintain quality of life. Routine assessment of risk factors and simple preventive steps make meaningful differences over time.
If evaluation or treatment is required, Manipal Hospital Jayanagar offers comprehensive bone health services, including DEXA scanning, specialist rheumatology consultation, and access to the full range of medical therapies. For assessment and management, patients may consult Dr. Prashant Bafna and the rheumatology team.
Book an appointment for a bone health assessment at Manipal Hospital Jayanagar today.
FAQ's
Adults at risk, postmenopausal women aged > 65, men aged > 70, and those with fragility fractures, long-term steroid use, or disorders of the bone should undergo a DEXA scan. Frequency varies according to baseline findings and treatment: typically every 1–3 years.
Osteoporosis can be stabilised and, in certain instances, bone density improved with proper therapy, particularly when treatment is initiated before fractures. Anabolic agents will add bone mass to selected patients.
Calcium and vitamin D are cornerstones but are frequently inadequate on their own for patients at high fracture risk. Pharmacologic treatment (bisphosphonates, denosumab, or anabolic agents) is appropriate based on fracture risk assessment.
Yes. Though more prevalent in women, osteoporosis does occur in men, most notably in older men and those with risk factors of hypogonadism, corticosteroid therapy, heavy alcohol, or smoking.
Ensure adequate lighting, remove tripping hazards, secure rugs, use non-slip footwear, install grab bars where needed, manage vision problems, and incorporate strength- and balance-building exercises into routine activity.
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