In osteoporosis the bones lose mass and their inner structure thins, so they break with little force, such as a fall from standing height. It causes no symptoms until a fracture happens, which is why screening older women and other high risk patients matters.
Key symptoms
- Usually no symptoms until a bone breaks
- Sudden back pain from a vertebral compression fracture
- Loss of height and a stooped, rounded upper back
- Hip or wrist fracture after a minor fall
What you find on exam
- Measured height compared with past records
- Thoracic kyphosis and tenderness over the spine
- Gait, balance and strength to judge fall risk
- Clues to a secondary cause: very thin build, steroid features, signs of thyroid disease
Tests
- DEXA scan: T-score of -2.5 or lower at the hip or spine
- FRAX score to estimate the 10-year fracture risk
- Calcium, vitamin D, kidney function and thyroid tests to look for secondary causes
- Spine X-ray if back pain or height loss suggests a hidden fracture
Treatment basics
- Calcium and vitamin D, weight-bearing exercise, stop smoking, limit alcohol
- A bisphosphonate such as alendronate as first-line drug therapy
- Denosumab, or bone-building drugs such as teriparatide for very high risk
- Fall prevention: home safety, vision check, review of sedating medicines
Red flags
- Hip pain and inability to bear weight after a fall
- New back pain with leg weakness, numbness or bladder problems
- Fracture with weight loss or night bone pain, which may point to cancer
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.