Osteoporosis is diagnosed with dual-energy X-ray absorptiometry (DEXA) scan — measuring bone mineral density at the hip and spine. A T-score of -2.5 or below confirms osteoporosis. Osteopenia is diagnosed between -1.0 and -2.5. FRAX — a fracture risk assessment tool — also incorporates clinical risk factors to guide treatment decisions.

Not necessarily — treatment decisions are based on fracture risk rather than bone density alone. FRAX estimates 10-year fracture probability. Patients above treatment thresholds, those with a prior fragility fracture, or those with very low bone density typically benefit from medication. All patients benefit from calcium, vitamin D, and exercise regardless of medication status.

Bisphosphonates (alendronate, risedronate, zoledronic acid) are first-line — they reduce vertebral and hip fracture risk by 40–65%. Denosumab, romosozumab, and teriparatide are alternatives for high-risk patients or bisphosphonate intolerance. Hormone therapy is an option for perimenopausal women with concurrent symptom burden.

Guidelines suggest a 'drug holiday' after 3–5 years of oral bisphosphonates in lower-risk patients — bone benefits persist for some time after stopping due to the drug's binding to bone matrix. Higher-risk patients often continue therapy longer. This is an individualized decision reviewed periodically with your clinician.

Oral bisphosphonates may cause esophageal irritation — taken with a full glass of water while remaining upright for 30 minutes minimizes this. Osteonecrosis of the jaw and atypical femur fractures are rare but important long-term risks. Denosumab requires careful follow-up as stopping abruptly causes rebound bone loss. Teriparatide may cause dizziness and leg cramps. Osteoporosis Treatment visit What to expect from a Osteoporosis Treatment visit