Osteoporosis is a skeletal disease characterized by low bone density and deterioration of bone microarchitecture, leading to increased bone fragility and fracture risk. It is often called a "silent disease" because bone loss occurs without symptoms — until a fracture happens. Osteoporosis affects 10 million Americans, and another 44 million have low bone mass (osteopenia), placing them at increased risk.
Who Is at Risk?
Risk factors include:
- Female sex (women have lower peak bone mass and accelerated bone loss after menopause)
- Age (bone density peaks in the late 20s and gradually declines)
- Family history of osteoporosis or hip fracture
- Low body weight
- Long-term glucocorticoid (steroid) use
- Smoking and excessive alcohol use
- Low calcium and vitamin D intake
- Sedentary lifestyle
- Early menopause or prolonged low estrogen
- Secondary causes: hyperthyroidism, hyperparathyroidism, malabsorption, multiple myeloma, and others
Diagnosis — Bone Density Testing (DEXA)
Bone mineral density (BMD) is measured by dual-energy X-ray absorptiometry (DEXA scan), which measures the hip and spine. Results are reported as a T-score:
| T-score | Interpretation |
|---|---|
| -1.0 or above | Normal bone density |
| -1.0 to -2.5 | Osteopenia (low bone mass) |
| -2.5 or below | Osteoporosis |
DEXA screening is recommended for all women 65+ and for younger postmenopausal women with risk factors. The FRAX tool (WHO fracture risk assessment) combines BMD with clinical risk factors to estimate 10-year fracture probability and guide treatment decisions.
Prevention
- Adequate calcium intake: 1,000 mg/day for adults under 50; 1,200 mg/day for women 51+ and men 71+
- Vitamin D: 600–800 IU/day; higher doses for those who are deficient
- Regular weight-bearing exercise (walking, jogging, dancing) and resistance training
- Avoid smoking and limit alcohol
- Fall prevention strategies (balance exercises, home safety assessment)
Treatment
Pharmacological treatment is recommended for:
- Osteoporosis diagnosis (T-score ≤ -2.5)
- Fragility fracture (hip or vertebra)
- Osteopenia with a high FRAX 10-year fracture risk (≥3% hip, ≥20% major)
Medication options:
- Bisphosphonates (alendronate, risedronate, zoledronate): First-line; reduce fracture risk by 40–70%; oral weekly/monthly or IV yearly
- Denosumab (Prolia): Injectable every 6 months; highly effective; requires careful monitoring of calcium and rebound if discontinued
- Teriparatide / Abaloparatide: Anabolic (bone-building) agents; used for severe osteoporosis; daily injections for up to 2 years
- Romosozumab (Evenity): Dual-action (builds bone and reduces breakdown); monthly injection for 1 year; for very high-risk patients
- Hormone therapy: Estrogen reduces fracture risk; may be appropriate for postmenopausal women with osteoporosis who also have menopausal symptoms
⚠️ Critical Prolia Safety Note: Patients on Prolia (denosumab) must never miss an injection or stop without a transition plan. Abrupt discontinuation causes rapid rebound bone loss and has resulted in multiple vertebral fractures. Always contact your endocrinologist before stopping or delaying Prolia.
In-Depth Guides by Medication
Click any medication to learn how it works, dosing, side effects, and whether it may be right for you:
RANK-L inhibitor · Every 6 months · Never miss a dose
Dual anabolic + antiresorptive · Monthly × 12 mo · High-risk
Anabolic · Daily injection · Up to 2 years
Anabolic · Daily injection · 86% vertebral fracture reduction
IV infusion · Once yearly · Most potent bisphosphonate
Bisphosphonate · Weekly pill · Most widely prescribed
Bisphosphonate · Atelvia taken after breakfast (no fasting)
SERM · Daily pill · Also reduces breast cancer risk 44%
Frequently Asked Questions About Osteoporosis Treatment
What is the most important thing to know about Prolia?
Never stop Prolia without a transition plan. Unlike bisphosphonates, Prolia's effect wears off rapidly — missing a dose or stopping abruptly can cause severe rebound bone loss and multiple vertebral fractures. If you need to stop for any reason, your endocrinologist will prescribe a bridging bisphosphonate. Call us immediately if you've missed a dose or are considering stopping.
What is the difference between anabolic and antiresorptive osteoporosis medications?
Antiresorptive medications (Prolia, bisphosphonates like Fosamax and Reclast, raloxifene) work by slowing bone breakdown — they preserve existing bone but don't create new structure. Anabolic medications (Forteo, Tymlos, Evenity) actively stimulate new bone formation. Anabolic therapy is typically reserved for severe osteoporosis or patients at very high fracture risk. An endocrinologist determines which approach — or which sequence — is best for you.
How long should I take osteoporosis medication?
It depends on the medication. Anabolic medications (Forteo, Tymlos) are limited to 2 years; Evenity is given for exactly 12 months. Bisphosphonates (Fosamax, Reclast) are typically reassessed after 3–5 years — lower-risk patients may take a "drug holiday." Prolia can be continued long-term but requires a careful transition if ever stopped. Raloxifene can be continued long-term in appropriate patients. Your endocrinologist will guide timing based on your bone density trends and fracture risk.
Do I need calcium and vitamin D supplements with osteoporosis medication?
Yes — calcium and vitamin D are required with all osteoporosis medications. Low calcium or vitamin D undermines the effectiveness of treatment and can cause complications (especially with Prolia and Reclast). Most adults need 1,000–1,200 mg of calcium daily (preferably from food) and 1,000–2,000 IU of vitamin D3. Your endocrinologist will check your vitamin D level and recommend the right supplementation for you.
How do I know if my osteoporosis medication is working?
The primary way to monitor treatment response is serial DEXA scans — typically every 1–2 years. Bone turnover markers (blood tests like P1NP and CTX) provide earlier feedback on how treatment is affecting bone metabolism. Importantly, stable or increasing bone density and no new fractures are the goals. Your endocrinologist will interpret your DEXA results in the context of your fracture history and medication.
Can an endocrinologist treat osteoporosis in Houston?
Yes — endocrinologists are the specialists most trained in bone metabolism and complex osteoporosis management. Our board-certified endocrinologists at Endocrine & Diabetes Plus Clinic of Houston evaluate bone density, identify secondary causes of bone loss (thyroid, parathyroid, vitamin D, steroid use), and prescribe and manage all osteoporosis medications. We serve Sugar Land, Memorial City, and the greater Houston area. Call 832-968-7003 or book online.
Key Takeaways
- Osteoporosis is a "silent disease" — fractures are often the first sign
- DEXA scan measures bone density — screening recommended for all women 65+
- Calcium, vitamin D, exercise, and fall prevention are the foundation of care
- Multiple effective medications reduce fracture risk by 40–70%
- An endocrinologist should evaluate for secondary causes and guide treatment decisions