Osteoporosis is a treatable condition, and treatment lowers the risk of fractures. Endocrinologists look beyond the bone density number: we look for the hormonal and metabolic causes behind bone loss and choose a medicine, and a plan for stopping or switching it, that fits your fracture risk. DEXA scans are performed at our new Bone Health Clinic in La Mesa.
Who should be evaluated
- Women 65 and older, men 70 and older
- Younger adults with a fracture from a minor fall, long-term steroid use, early menopause, low testosterone, hyperparathyroidism, celiac disease or other risk factors
- Anyone whose bone density is falling despite treatment
DEXA and fracture risk
A DEXA scan measures bone density; FRAX combines it with other risk factors to estimate your 10-year fracture risk. Treatment decisions rest on both. T-scores explained.
Finding secondary causes
A substantial share of osteoporosis in women, and more in men, has a contributing cause. We check calcium, vitamin D, parathyroid hormone, thyroid function and kidney function and, when indicated, testosterone, cortisol and celiac antibodies. Treating the cause can be as important as the bone medicine. Causes of osteoporosis.
Choosing a medicine
- Bisphosphonates (alendronate, risedronate, zoledronic acid) for most people at moderate risk
- Denosumab (Prolia) every six months; effective, but must not be stopped without a plan (stopping Prolia safely)
- Bone-building (anabolic) medicines: teriparatide (Forteo), abaloparatide (Tymlos) and romosozumab (Evenity), for very high risk or recent fractures, followed by an antiresorptive to keep the gain
Osteoporosis medications compared.
Drug holidays and stopping Prolia
Some patients on bisphosphonates can pause after several years. Denosumab is different: stopping it without a follow-on medicine can cause rapid bone loss and multiple spine fractures. We plan every transition in advance.
After a fracture
A fracture is the strongest predictor of the next one. If you have broken a bone from a minor fall, ask your doctor about an osteoporosis evaluation.
Request an appointment
We see patients with osteoporosis at our La Jolla, La Mesa and Poway offices; DEXA scans are done at the La Mesa Bone Health Clinic. Request an appointment or call (858) 622-7200.
Sources: Eastell R, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2019;104:1595–1622. Shoback D, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update. J Clin Endocrinol Metab. 2020;105:587–594. Camacho PM, et al. AACE/ACE Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis—2020 Update. Endocr Pract. 2020;26(Suppl 1):1–46. Written by Mba Uzoma Mba, MD, PhD; reviewed by Darius A. Schneider, MD, PhD. October 2026.
