Osteoporosis Management & Prevention: A Comprehensive Action Plan

Osteoporosis Management & Prevention: A Comprehensive Action Plan

Osteoporosis is manageable and largely preventable. This dual-track approach addresses both—because whether you're treating established disease or protecting future bone, the pillars are the same.

Management (If Diagnosed)

1. Pharmacotherapy: First-line: oral/IV bisphosphonates (alendronate, zoledronate). Alternatives: denosumab (q6mo SC), anabolics (teriparatide, abaloparatide, romosozumab) for very high fracture risk. Raloxifene (postmenopausal women) — also ↓ breast cancer risk.
2. Exercise prescription: Progressive resistance training 2–3×/wk (spine/hip loading). Balance/fall prevention (Tai Chi, Otago). Avoid spinal flexion (crunches, toe touches).
3. Nutrition: Ca 1,200 mg/day (food first), Vit D 30–50 ng/mL, Protein 1.0–1.2 g/kg, K2, Mg.
4. Lifestyle: Smoking cessation (critical). Alcohol ≤1 drink/day. Fall-proof home.
5. Monitoring: DEXA q1–2 yrs; height measurement annually; fracture assessment.

Prevention (Lifelong)

1. Peak bone mass optimization (childhood–30): Ca/D, impact sports, avoid eating disorders/RED-S.
2. Maintenance (30–50): Sustain habits; perimenopausal women: anticipate acceleration.
3. Early postmenopause / andropause: Screen (DEXA at 65 women / 70 men, or earlier with risk factors). Intervene early.
4. Secondary prevention: After first fracture — treat aggressively. 20% refracture within 1 yr.

Clinical Decision Points

• FRAX® 10-yr major osteoporotic fracture risk ≥20% or hip ≥3% → treat.
• Vertebral fracture on imaging (VFA or lateral spine) → treat regardless of T-score.
• Glucocorticoid users: treat if ≥7.5 mg/day × 3 mo + age >40 or prior fracture.

Osteoporosis isn't a sentence—it's a call to action. Bones respond to load, nutrients, and medicine. You have agency.