Osteoporosis

1. Big picture

Osteoporosis is a silent systemic skeletal disease in which bone strength is reduced, so a low-energy fall can cause a fracture. The exam logic is simple:

low bone mass + damaged bone microarchitecture → fragile bone → vertebral, hip, distal radius, and humerus fractures

The examiner wants you to know:

1. How to define osteoporosis.
2. Who should be screened.
3. How to interpret dual-energy X-ray absorptiometry (DXA) using T-score.
4. How to distinguish osteoporosis from osteomalacia, hyperparathyroidism, metastases, and myeloma.
5. How to treat: lifestyle, calcium/vitamin D, fall prevention, antiresorptive drugs, anabolic drugs.
6. When to use bisphosphonates, denosumab, teriparatide, and romosozumab.
7. The major complications: hip fracture mortality, vertebral fractures, chronic pain, kyphosis, loss of independence.

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