Osteoporosis — guide.

What osteoporosis is

Osteoporosis is a disease of the skeleton in which both bone density and bone quality decrease, making the bone porous and fragile. Bone tissue is continuously renewed through a balance between formation and resorption; in osteoporosis, resorption exceeds formation, and the bones become prone to fractures even with minor trauma. The typical locations of osteoporotic fractures are the hip, the spine and the forearm. The disease is often silent — the first manifestation may even be the fracture itself. Women at menopause are the most affected, because of the decline in estrogens, which protect bone. Prevention through adequate calcium and vitamin D intake, exercise and screening by bone densitometry significantly reduces fracture risk.

Risk factors

Menopause (estrogen deficiency), advanced age, female sex, family history, low body weight, sedentary lifestyle, smoking, alcohol, calcium and vitamin D deficiency, chronic corticosteroid therapy and certain diseases (hyperthyroidism, Cushing's syndrome, celiac disease).

Diagnosis

DXA bone densitometry — a T-score ≤ -2.5 confirms osteoporosis, while values between -1 and -2.5 indicate osteopenia. The 10-year fracture risk is estimated with the FRAX score.

Treatment

Lifestyle:

• Calcium 1000-1200 mg/day (from diet or supplement).
• Vitamin D3 800-2000 IU/day, keep 25-OH-D above 30 ng/ml.
• Weight-bearing exercise (walking, dancing, tennis) 30-45 min/day.
• Balance exercises (prevent falls).
• Smoking cessation, alcohol limitation.
• Adequate protein intake.

Medication (Rx):

• Bisphosphonates (alendronate, risedronate, zoledronate) — first line.
• Denosumab (Prolia) — monoclonal antibody.
• Teriparatide, romosozumab — anabolics, severe cases.
• Raloxifene in postmenopausal women.
• Hormone replacement therapy — beneficial in those with menopausal symptoms.

Essential OTC

• Calcium (citrate is better absorbed) 500-600 mg twice a day.
• Vitamin D3 1000-2000 IU/day.
• Vitamin K2 (menaquinone) 90-180 mcg/day — directs calcium toward the bones.
• Magnesium — important for calcium absorption.
• Hydrolyzed collagen — emerging evidence.

Medical disclaimer: the information in this guide is for informational purposes and does not replace the advice of a doctor or pharmacist. For diagnosis and treatment, consult a healthcare professional.