What is osteoporosis?

Osteoporosis is a skeletal disease characterised by reduced bone mineral density and deterioration of bone microarchitecture — increasing bone fragility and fracture risk. Diagnosed by DEXA scan: T-score ≤-2.5. Osteopenia (T-score -1.0 to -2.5) indicates intermediate fracture risk. The disease is largely asymptomatic until a fracture occurs — hence the term "silent epidemic". It affects approximately 200 million women globally, with 1 in 3 women and 1 in 5 men over 50 sustaining a fragility fracture (fracture from a fall from standing height or less).

What are the risk factors for osteoporosis?

Non-modifiable: older age (bone loss accelerates after age 50 in women and 65 in men); female sex; menopause (oestrogen deficiency causes accelerated bone loss of 2-3%/year for 5-10 years post-menopause); small body frame/low BMI; family history of osteoporosis or hip fracture; ethnicity (White and Asian populations higher risk). Modifiable: smoking (approximately 25% higher fracture risk); alcohol >3 units/day; physical inactivity; vitamin D and calcium deficiency. Secondary causes: glucocorticoid use (most common secondary cause); rheumatoid arthritis; coeliac disease; inflammatory bowel disease; hyperparathyroidism; hypogonadism; thyroid disease; chronic kidney disease; cancer treatments.

Who should be screened for osteoporosis?

Initiate FRAX assessment (frax.shef.ac.uk) for: all women ≥65 years; men ≥70 years; postmenopausal women or men >50 with clinical risk factors (prior fragility fracture, family history of hip fracture, low BMI, glucocorticoid use, smoking, alcohol, chronic disease). Proceed to DEXA scan based on FRAX result above country-specific intervention threshold. Priority groups for immediate DEXA: any patient starting systemic glucocorticoids ≥3 months; anyone with a fragility fracture (fracture liaison services — FLS); clinical high-risk patients.

What treatment is available?

Non-pharmacological (for all): calcium (1000-1200mg/day through diet ± supplements); vitamin D (800-1000 IU/day); weight-bearing and resistance exercise; fall prevention; smoking cessation; alcohol reduction. Pharmacological: bisphosphonates (alendronate, risedronate, zoledronic acid IV) — first-line; reduce vertebral fractures by 40-70%, hip fractures by approximately 40%. Denosumab (Prolia) — anti-RANKL injection every 6 months; suitable for CKD. Romosozumab (Evenity) — 12 months anabolic; for high-risk. Teriparatide/abaloparatide — PTH analogues; anabolic; for very high-risk or failure of antiresorptive therapy.

What is a fracture liaison service?

A fracture liaison service (FLS) is a systematic, coordinator-based programme ensuring every patient presenting with a fragility fracture is identified, assessed (DEXA + blood tests + FRAX), treated (vitamin D, calcium, anti-osteoporotic drugs), and followed up. FLS is the most effective healthcare system intervention for secondary fracture prevention — patients who have had one fragility fracture are at dramatically higher risk of a second. Without FLS, the majority of fracture patients leave hospital without any osteoporosis assessment or treatment.

How does GMJ News cover osteoporosis?

GMJ News covers IOF/WHO fracture burden, DEXA and T-score diagnosis, FRAX risk calculator, bisphosphonate treatment, denosumab and romosozumab for high-risk patients, glucocorticoid-induced osteoporosis, falls prevention, and fracture liaison services. Osteoporosis — one of the most underdiagnosed major conditions — is directly relevant to PHIG's ageing and NCD programme in Georgia.

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Osteoporosis

GMJ News knowledge hub · last reviewed September 2026 · Georgian Medical Journal

Summary Statistics Glossary GMJ news FAQ Documents Organizations Research

Osteoporosis — defined by reduced bone mineral density (T-score ≤−2.5 on DEXA scan) causing increased fracture risk — affects an estimated 200 million women globally and results in more than 8.9 million fractures per year, with hip fractures carrying a 20-30% mortality within 12 months and a profound loss of independence in those who survive — making osteoporosis one of the leading causes of morbidity and mortality in older populations, yet among the most systematically underdiagnosed and undertreated conditions in medicine (WHO). Effective prevention and treatment — bisphosphonates, denosumab, romosozumab, calcium, vitamin D, fall prevention and the WHO FRAX fracture-risk calculator — can prevent the majority of osteoporotic fractures when identified and managed proactively.

Key messages

1 in 3 women, 1 in 5 men over 50 fracture — 20-30% die after hip fracture

One in three women and one in five men over age 50 will experience an osteoporotic fracture. Hip fractures carry 20-30% mortality within 12 months, and 50% of survivors never regain pre-fracture mobility (WHO/IOF).

T-score ≤-2.5 = osteoporosis — DEXA is the diagnostic test

Bone mineral density (BMD) measured by DEXA (dual-energy X-ray absorptiometry): T-score -1.0 to -2.5 = osteopenia; T-score ≤-2.5 = osteoporosis. The hip (femoral neck) and lumbar spine are the primary measurement sites.

FRAX — the 10-year fracture risk calculator

The WHO FRAX tool (frax.shef.ac.uk) calculates an individual's 10-year probability of hip and major osteoporotic fracture from clinical risk factors (age, sex, BMI, prior fracture, smoking, alcohol, glucocorticoids, secondary osteoporosis, family history) — with or without BMD.

Bisphosphonates — first-line treatment

Bisphosphonates (alendronate, risedronate, zoledronic acid IV annually) are the first-line pharmacological treatment for osteoporosis — reducing vertebral fractures by approximately 40-70% and hip fractures by approximately 40%. Drug holidays are appropriate after 3-5 years of bisphosphonate use for most patients.

Denosumab and romosozumab for high-risk

Denosumab (Prolia, anti-RANKL injection every 6 months) reduces hip fractures by 40%. Romosozumab (Evenity, anti-sclerostin — both builds bone AND reduces resorption) reduces vertebral fractures by 73% in the first year — the most potent anti-fracture agent available. Requires specialist prescribing.

Glucocorticoid-induced osteoporosis — the hidden epidemic

Systemic glucocorticoids ≥7.5mg prednisolone equivalent for ≥3 months cause significant bone loss. Fracture risk is elevated even at low doses and from day 1 of treatment. WHO/ACR recommend bisphosphonate or denosumab co-prescription for most patients on chronic glucocorticoids.

Key statistics

200M

women affected by osteoporosis globally (IOF/WHO)

IOF/WHO

8.9M

osteoporotic fractures/year globally (IOF)

IOF

20-30%

mortality within 12 months of hip fracture

IOF/WHO

1 in 3

women over 50 will sustain an osteoporotic fracture

IOF/WHO

T-score ≤-2.5

WHO DEXA diagnostic threshold for osteoporosis

WHO

40-70%

vertebral fracture reduction with bisphosphonate therapy

Cochrane/WHO

Osteoporotic fracture risk by site and age — women (IOF)

Source: IOF/WHO. Hip fractures: highest mortality. Vertebral fractures: most common but often undetected.

Glossary of key terms

T-score
WHO/DEXABone mineral density expressed as standard deviations from the mean peak bone mass of a young adult reference population. T-score ≥-1.0: normal; -1.0 to -2.5: osteopenia (low bone mass, increased fracture risk); ≤-2.5: osteoporosis. Z-score: comparison with age-matched peers — used in younger patients and men under 50.

FRAX (Fracture Risk Assessment Tool)
WHO/SheffieldWHO-endorsed online calculator (frax.shef.ac.uk) that estimates an individual's 10-year probability of hip fracture and major osteoporotic fracture (hip, spine, forearm, humerus). Inputs: age, sex, BMI, country, prior fragility fracture, family history of hip fracture, current smoking, alcohol ≥3 units/day, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis — with or without BMD (T-score).

Bisphosphonates
WHO EMLSynthetic analogues of pyrophosphate that bind hydroxyapatite in bone and inhibit osteoclast-mediated resorption. Main agents: alendronate (70mg weekly oral) and risedronate (35mg weekly oral) — first-line for most patients; zoledronic acid (5mg IV annually) — for those who cannot take oral bisphosphonates or with poor adherence. Side effects: oesophageal irritation (oral — take with water, remain upright); atypical femoral fractures and osteonecrosis of the jaw (rare — with prolonged use >5 years, especially in oncology settings).

Denosumab (Prolia)
EMA/FDAA human monoclonal antibody against RANKL (receptor activator of nuclear factor-κB ligand) — the key osteoclast differentiation signal. Subcutaneous injection 60mg every 6 months. Reduces hip fractures by approximately 40%, vertebral by approximately 68%. Important: rebound fracture risk on discontinuation — must transition to bisphosphonate when stopping. Not renally excreted — safe in CKD.

Romosozumab (Evenity)
EMA/FDAA monoclonal antibody against sclerostin — inhibiting WNT signalling inhibition, thereby increasing bone formation AND reducing bone resorption (dual mechanism). Monthly SC injections × 12 months; then bisphosphonate or denosumab. The ARCH trial: romosozumab then alendronate reduced vertebral fractures by 73% vs alendronate alone. Use restricted to high fracture risk patients; avoid in patients with prior MI or stroke (cardiovascular safety signal).

Falls prevention
WHOApproximately 90% of osteoporotic hip fractures result from falls — making falls prevention as important as pharmacological treatment. Interventions: home safety assessment (remove trip hazards, install grab bars); strength and balance training (Tai Chi, physiotherapy — reduces falls by approximately 25%); vision correction; medication review (stopping sedatives, antihypertensives causing orthostasis); vitamin D correction (reduces fall risk).