Osteoporosis
Loss of bone density and strength that raises fracture risk. Silent until a fracture occurs — the lab work-up identifies treatable contributors.
What it is
Osteoporosis is the systemic skeletal disease characterised by reduced bone density and disrupted bone architecture, leading to increased fracture risk. The classic presenting fracture is a hip, vertebra or wrist after minimal trauma. Bone density peaks in the third decade and declines from there — accelerated by menopause in women, by hypogonadism in men, and by glucocorticoid use, hyperthyroidism, hyperparathyroidism, vitamin D deficiency and chronic kidney disease. Roughly one in three women and one in five men over 50 will sustain an osteoporotic fracture in their lifetime.
Key lab markers
- 25-OH vitamin D — central to calcium absorption; deficiency drives secondary hyperparathyroidism and bone loss.
- Calcium — total + corrected for albumin; rules out primary hyperparathyroidism.
- Alkaline phosphatase — elevated in active bone turnover.
- PTH — primary or secondary hyperparathyroidism are reversible contributors.
- TSH — hyperthyroidism accelerates bone loss.
- Creatinine — chronic kidney disease changes treatment options.
- DEXA scan — the diagnostic test; T-score ≤-2.5 defines osteoporosis.
Symptoms
Osteoporosis itself is asymptomatic. Presentation is usually the first fracture or, in advanced disease:
- Loss of height (>3 cm)
- Stooped posture
- Chronic back pain from vertebral compression fractures
- Fracture after minimal trauma (fall from standing height)
When to discuss with a doctor
Women over 65, men over 70, or anyone with risk factors (early menopause, glucocorticoid use, rheumatoid arthritis, low body weight, smoking, heavy alcohol, prior fragility fracture) should discuss DEXA screening with their primary-care doctor. Treatment combines vitamin D + calcium adequacy with antiresorptive therapy (bisphosphonates, denosumab) or anabolic therapy in selected patients. Falls prevention is as important as drug therapy.