Rheumatology

Osteoporosis

Systemic skeletal disorder with reduced bone mass and microarchitectural deterioration causing fragility fractures; T-score <=-2.5 on DEXA.

Last reviewed 23 Jun 2026 - MedicoMedics editorial team

Pathophysiology

Imbalance between osteoclast resorption and osteoblast formation; oestrogen deficiency, ageing, glucocorticoids, hyperparathyroidism accelerate loss.

Sources: AACE 2020 Osteoporosis; Endocrine Society Menopause 2019

Presentation

Silent until fracture: vertebral compression, hip, distal radius (Colles); height loss, kyphosis; back pain.

Diagnosis

DEXA T-score <=-2.5 (postmenopausal women, men >=50) or fragility fracture at hip/vertebra regardless of T-score. FRAX assesses 10-year fracture risk.

Management

Calcium 1000-1200 mg/day, vitamin D 800-1000 IU, weight-bearing exercise, fall prevention. Pharmacotherapy: bisphosphonates (alendronate, zoledronic acid), denosumab, romosozumab (very high risk), teriparatide.

Sample USMLE-style MCQs

Try 5 questions on this topic. Practice hundreds more free with a trial.

Question 1

A 67-year-old postmenopausal woman has a T-score of -2.8 at spine and prior wrist fracture. Best first therapy?

Question 2

Which agent stimulates bone formation (anabolic)?

Question 3

Contraindication to romosozumab?

Question 4

Which lab is essential before starting bisphosphonate?

Question 5

Feared complication of denosumab discontinuation?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 23 Jun 2026 by MedicoMedics editorial team.

Frequently asked

Duration of bisphosphonate?

5 y oral or 3 y IV then drug holiday if risk moderate.

Denosumab risk?

Rebound vertebral fractures if discontinued abruptly - transition to bisphosphonate.

Screening age?

Women >=65, men >=70 or younger with risk factors.

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