Osteoporosis: Risk Factors, DEXA Scan Interpretation & Best Drug Therapy 2025

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Here is a **concise but complete, SEO-friendly medical reference** for your title **“Osteoporosis: Risk Factors, DEXA Scan Interpretation & Best Drug Therapy 2025”** — structured exactly the way you prefer for your medical knowledge hubs. --- # **Osteoporosis: Risk Factors, DEXA Scan Interpretation & Best Drug Therapy 2025** ## **Definition** Osteoporosis is a systemic skeletal disorder characterized by **low bone mass**, **microarchitectural deterioration**, and **increased fracture risk**, commonly affecting postmenopausal women and elderly men. --- # **Pathophysiology** * **Increased bone resorption** vs **decreased bone formation**. * Loss of **trabecular connectivity**, thinning of cortical bone. * Estrogen deficiency → ↑ osteoclast activity. * Age-related decline in osteoblast function. * Secondary causes involve hormonal, nutritional, renal, GI, or drug-induced factors. --- # **Risk Factors** ### **Non-modifiable** * Age > 65 (women), > 70 (men) * Female sex * Postmenopausal status * Family history of hip fracture * Low BMI (<19) ### **Modifiable** * Smoking, alcohol intake >3 units/day * Sedentary lifestyle * Low calcium/vitamin D intake * Poor sunlight exposure ### **Secondary Causes** * Endocrine: Hyperthyroidism, hyperparathyroidism, Cushing, hypogonadism * GI: Malabsorption, celiac disease, bariatric surgery * Renal: CKD–mineral bone disorder * Drugs: **Steroids**, PPIs, anticonvulsants, heparin, aromatase inhibitors * Rheumatologic: RA, SLE --- # **Clinical Features** * Usually **asymptomatic** until fracture * Fragility fractures: vertebral (most common), hip, forearm * Height loss, kyphosis, back pain * Decreased mobility and functional impairment --- # **Diagnosis** ## **1. DEXA Scan (Dual-Energy X-Ray Absorptiometry)** ### **T-Score Interpretation** | T-Score | Interpretation | | ---------------------------------- | ----------------------- | | **≥ –1.0** | Normal | | **–1.0 to –2.5** | **Osteopenia** | | **≤ –2.5** | **Osteoporosis** | | **≤ –2.5 with fragility fracture** | **Severe Osteoporosis** | ### **Sites to Measure** * **Lumbar spine (L1–L4)** * **Total hip** * **Femoral neck** ### **When to Repeat** * Every **1–2 years** depending on therapy response. --- ## **2. FRAX Score** Estimates 10-year risk of **major osteoporotic fracture** and **hip fracture** using age, sex, BMI, and clinical risk factors. **Treatment thresholds (India/Asia 2025 recommendations):** * Major fracture risk ≥20% * Hip fracture risk ≥3% --- # **Investigations for Secondary Causes** * Calcium, phosphate * Vitamin D (25-OH) * PTH * TSH * Renal & liver function * Testosterone (men) * SPEP if myeloma suspected --- # **Management** ## **1. Non-Pharmacologic** * Weight-bearing exercises * Smoking/alcohol cessation * Calcium 1200 mg/day (diet + supplement) * Vitamin D3 800–2000 IU/day * Fall-prevention strategies --- # **2. Pharmacologic Therapy (Updated 2025)** **A. First-Line Agents** ### **⬤ Bisphosphonates (Alendronate, Risedronate, Zoledronic acid)** * **MOA:** Inhibit osteoclast-mediated bone resorption * **Dosing:** * Alendronate 70 mg weekly * Risedronate 35 mg weekly * Zoledronic acid 5 mg IV yearly * **AEs:** Esophagitis, hypocalcemia, atypical femur fractures (long-term), ONJ * **Contraindications:** eGFR <35 mL/min, esophageal motility disorders * **Monitoring:** Calcium, vitamin D, dental evaluation * **Counselling:** Take fasting with water; remain upright 30–60 mins. ### **⬤ Denosumab** * **MOA:** RANKL monoclonal antibody → ↓ osteoclast survival * **Dose:** 60 mg SC every 6 months * **AEs:** Hypocalcemia, infections, ONJ, rebound fractures if stopped * **Important:** Must transition to bisphosphonate when discontinuing. --- **B. Anabolic Agents (Severe or High-Risk Osteoporosis)** ### **⬤ Teriparatide / Abaloparatide** * **MOA:** PTH analog → stimulates osteoblast activity * **Dose:** 20 µg SC daily * **Duration:** Max 24 months * **AEs:** Hypercalcemia, leg cramps * **Use when:** T-score < –3.0, multiple fractures, or failure of antiresorptives. ### **⬤ Romosozumab (2025 availability improving)** * **MOA:** Sclerostin inhibitor → ↑ bone formation + ↓ resorption * **Dose:** 210 mg SC monthly for 12 months * **Contra:** Recent MI/stroke * **AEs:** CV risk, ONJ, atypical femur fractures --- **C. SERMs (Raloxifene)** * **Useful in younger postmenopausal women** * Prevents vertebral fractures only * AEs: Hot flashes, VTE risk --- # **Treatment Algorithm 2025** 1. **Low risk / Osteopenia:** * Lifestyle + calcium/Vit D * Consider bisphosphonate if FRAX above threshold 2. **Moderate to high risk:** * Start bisphosphonate (first-line) * Reassess DEXA at 1–2 years 3. **Very high risk or severe osteoporosis:** * Start **anabolic agent** (teriparatide or romosozumab) * Follow with antiresorptive agent for consolidation 4. **Secondary osteoporosis:** * Treat underlying cause (thyroid, steroids, malabsorption, etc.) --- # **Monitoring** * DEXA every 12–24 months * Serum calcium & vitamin D periodically * Monitor compliance and adverse effects --- # **Long-Tail SEO Tags (comma separated)** osteoporosis risk factors 2025, updated osteoporosis treatment guidelines, dexa scan interpretation chart, osteoporosis drugs comparison 2025, best medicine for osteoporosis 2025, romosozumab indications 2025, teriparatide dosing neet pg, osteoporosis in postmenopausal women, how to read dexa scan results, osteoporosis vs osteopenia differentiation, fragility fracture management, frx score osteoporosis threshold, bisphosphonate contraindications, denosumab side effects rebound fractures, osteoporosis prevention diet exercise --- If you want, I can also generate: ✅ **20–30 NEET PG-level MCQs (case-based) in HTML-CSS-JS one file** OR ✅ **SEO-optimized title variations** Just tell me **“give mcqs”** or **“give titles”**.