Osteoporosis — Frequently asked questions (FAQ)
1) What is osteoporosis?
Osteoporosis is a skeletal disorder characterised by reduced bone strength, which increases the risk of fragility fractures. These fractures occur after low-energy trauma, such as a fall from standing height, and most commonly affect the hip, spine and wrist.
2) What is a fragility fracture?
A fragility fracture is a fracture that occurs spontaneously or after low-energy trauma that would not normally cause a fracture in healthy bone. A previous fragility fracture significantly increases the risk of subsequent fractures.
3) When should osteoporosis be suspected?
Osteoporosis should be suspected in older people and in those with a history of fragility fracture, early menopause, low body weight, prolonged immobility, a family history of hip fracture or long-term use of medicines associated with bone loss, such as glucocorticoids.
4) When is bone densitometry (DXA) required?
Bone densitometry is useful for confirming osteoporosis and improving fracture risk stratification. However, treatment may be started without densitometry in certain situations, particularly after specific fragility fractures or in individuals at very high fracture risk.
5) What is FRAX?
FRAX is a tool that estimates the probability of an osteoporotic fracture over the next 10 years. It uses clinical factors such as age, sex, weight, previous fracture, smoking and glucocorticoid use and may be calculated with or without bone mineral density.
6) When is pharmacological treatment indicated?
Pharmacological treatment should be considered in individuals at high or very high fracture risk, in patients with certain fragility fractures and in specific situations identified through clinical assessment, FRAX and bone densitometry.
7) Which medicines are first-line treatments?
Oral bisphosphonates, such as alendronate and ibandronate, are generally used as first-line treatment. They reduce the risk of vertebral and non-vertebral fractures and have a favourable benefit–risk profile in most patients.
8) When should denosumab or zoledronic acid be used?
These options are particularly useful when oral bisphosphonates are contraindicated, not tolerated or difficult to use. The decision should take into account renal function, the risk of hypocalcaemia, treatment adherence and patient preferences.
9) When should teriparatide be considered?
Teriparatide is generally reserved for patients at very high fracture risk, such as those with multiple vertebral fractures, hip fracture or very low bone mineral density. It should be followed by antiresorptive treatment after discontinuation.
10) Is calcium and vitamin D supplementation necessary?
In most cases, an adequate intake of calcium and vitamin D should be ensured through diet or supplementation. Correction of vitamin D deficiency is particularly important before starting certain anti-osteoporosis treatments.
11) How should monitoring be performed?
Monitoring should include assessment of treatment adherence, the occurrence of new fractures and periodic reassessment of fracture risk. Repeating bone densitometry is rarely justified before 2–3 years, except in specific clinical circumstances.
12) Can bisphosphonates be discontinued?
In some patients with a good treatment response and a reduced fracture risk, a treatment pause (“drug holiday”) may be considered after several years of therapy. The decision should be individualised and based on fracture history, bone mineral density and current fracture risk.
