Osteoporosis & Metabolic Bone Diseases A Practical Guide for Patients & Primary Care Physicians
Author: Dr. Md. Abdul Bari Robel, MBBS, DEM
Diabetes, Thyroid, Obesity & Hormone Specialist
Introduction
Osteoporosis is a systemic skeletal disease characterized by reduced bone strength and an increased risk of fragility fractures. Early diagnosis and appropriate treatment reduce fracture risk and improve quality of life.
WHO Bone Mineral Density Classification
| T-score | Interpretation |
| ≥ -1.0 | Normal |
| -1.0 to -2.5 | Osteopenia (low bone mass) |
| ≤ -2.5 | Osteoporosis |
| ≤ -2.5 with fragility fracture | Severe osteoporosis |
Major Risk Factors
| Primary | Secondary |
| Advanced age, menopause | Hyperthyroidism |
| Low BMI | Hypogonadism |
| Family history | Glucocorticoid therapy |
| Smoking | Chronic kidney disease |
| Physical inactivity | Hyperparathyroidism |
Diagnosis
Assessment includes fracture history, DEXA bone mineral density, FRAX fracture risk assessment, and laboratory evaluation to identify secondary causes.
Recommended Investigations
| Investigation | Purpose |
| DEXA scan | Measure bone mineral density |
| Serum calcium, phosphate | Bone metabolism |
| 25-hydroxy vitamin D | Detect deficiency |
| PTH | Evaluate hyperparathyroidism |
| TSH | Screen for thyroid disease |
| Renal & liver function | Secondary causes |
Medical Treatment
| Medicine | Class | Main Use |
| Alendronate | Bisphosphonate | First-line in many patients |
| Zoledronic acid | Bisphosphonate | Annual intravenous therapy |
| Denosumab | RANKL inhibitor | High fracture risk |
| Teriparatide | PTH analogue | Very high fracture risk |
| Romosozumab | Sclerostin inhibitor | Selected very high-risk patients |
Glucocorticoid-Induced Osteoporosis
Patients receiving long-term glucocorticoid therapy should undergo fracture risk assessment and receive adequate calcium and vitamin D. Anti-osteoporosis medication should be considered according to fracture risk and current guideline recommendations.
Lifestyle
• Weight-bearing and resistance exercise
• Adequate calcium and vitamin D intake
• Smoking cessation
• Limit alcohol
• Fall prevention strategies
References
- Endocrine Society Guideline on Osteoporosis.
- AACE Clinical Practice Guideline for Postmenopausal Osteoporosis.
- National Osteoporosis Foundation Clinician’s Guide.
- American College of Rheumatology Guideline for Glucocorticoid-Induced Osteoporosis.