Bone Health, Osteopenia & Osteoporosis

Osteoporosis is a skeletal condition in which bone mass decreases and internal bone structure deteriorates, making bones significantly more prone to fracture. Trabecular bone — the spongy inner lattice — becomes thinner and less connected; the outer cortical shell loses density and thickness. The hip, spine, and wrist are most vulnerable.

Approximately 40% of women and 25% of men over age 50 will sustain an osteoporosis-related fracture in their lifetime, often with serious consequences for mobility and independence.

Bone is living tissue in continuous renewal. Osteoclasts break down old bone while osteoblasts build new bone — a process called remodeling. Bone mass peaks between ages 20–25, after which the balance gradually shifts toward net loss. Menopause dramatically accelerates this in women due to falling estrogen; men lose bone more gradually as testosterone declines. Osteoporosis develops when resorption chronically outpaces formation.

Osteopenia refers to bone density that is below normal but not yet in the osteoporotic range. It represents an important window for intervention. With the right combination of nutrition, exercise, and when appropriate, medication, further bone loss can be halted and fracture risk meaningfully reduced.

Several hormonal imbalances contribute to bone loss. Estrogen deficiency — whether from menopause, surgical removal of the ovaries, or suppression from excessive exercise or caloric restriction — is the most common driver in women. Excess cortisol, as in Cushing’s syndrome or with long-term corticosteroid therapy, accelerates bone resorption significantly. Because so many hormonal conditions intersect with bone health, endocrinologic evaluation is central to proper osteoporosis care.

Osteoporosis is often called a “silent disease” — bone loss advances without symptoms until a fracture occurs. Warning signs include a fragility fracture, loss of more than one inch of adult height, chronic back pain, or progressive forward curvature of the upper spine.

The standard diagnostic tool is a DEXA scan, which measures bone density and reports results as a T-score:

The FRAX algorithm estimates your 10-year probability of a major osteoporotic or hip fracture by combining bone density with clinical risk factors. Some patients whose bone density falls in the osteopenia range still warrant treatment when their overall fracture probability is high.

Trabecular Bone Score (TBS) is derived from the same DEXA scan images and assesses bone microarchitecture independently of density. Quantitative CT (QCT) provides true three-dimensional volumetric bone density, useful when DEXA results may be confounded by degenerative changes.

• –All women ≥ 65 and men ≥ 70
• –Postmenopausal women under 65 with clinical risk factors
• –Adults with conditions or medications known to cause bone loss
• –Anyone with a fragility fracture after age 50

Nutrition is foundational to bone health — medications work poorly without it.

Weight-bearing and resistance exercises stimulate bone formation, build muscle, and reduce fall risk. The right type and intensity must match your age, fitness level, and bone health status. Please speak with us before starting a new exercise regimen.

For older adults, fall prevention is as important as treating bone loss itself. Key measures include removing loose rugs and floor clutter, installing grab bars in bathrooms, ensuring adequate lighting in hallways and stairwells, and wearing flat rubber-soled footwear when unsteady.

Treatment is guided by overall fracture risk — not bone density alone.

Bisphosphonates Alendronate · Risedronate · Zoledronic Acid

The most widely used class. They inhibit bone resorption and reduce vertebral, non-vertebral, and hip fracture risk. Approved for postmenopausal and glucocorticoid-induced osteoporosis in both men and women.

Denosumab Prolia®

A potent RANK ligand inhibitor administered as a subcutaneous injection every six months.

Teriparatide & Abaloparatide Forteo® · Tymlos®

PTH analog agents that actively stimulate new bone formation. Reserved for patients with severe osteoporosis at high fracture risk. Administered as daily self-injections for a maximum of two years.

Romosozumab Evenity®

A sclerostin inhibitor that simultaneously increases bone formation and decreases resorption. Given monthly for 12 doses, after which transition to an antiresorptive agent is required.

Estrogen / Hormone Replacement Therapy

Estrogen consistently reduces fracture risk. Its benefit-to-risk profile is most favorable when initiated within five years of menopause.

Osteoporosis in men is significantly underdiagnosed. Alendronate, risedronate, zoledronic acid, and teriparatide are all FDA-approved for men and produce results comparable to those seen in women. We evaluate the full hormonal picture as part of every osteoporosis workup in our male patients.