Osteoporosis

In a nutshell

Osteoclast-driven resorption outpaces osteoblast-driven formation, thinning trabecular struts and cortical bone until minor trauma is enough to fracture. Osteoporosis is silent until a fragility fracture occurs, so risk is estimated proactively with FRAX and DEXA, and treated with bisphosphonates to rebalance the remodelling cycle.

Classic presentation

A postmenopausal woman who sustains a wrist, hip or vertebral fracture after a low-energy fall, or is found incidentally to have vertebral height loss, with no preceding bone pain.

Key points

• 1Osteoporosis reflects a chronic imbalance between osteoclast resorption and osteoblast formation, most commonly unmasked by post-menopausal oestrogen loss.