Osteoporosis in Women Over 60: Prevalence, Risk Factors & Prevention

Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration, leading to fragility fractures. It represents a major public health concern for aging women.

Epidemiology

• Prevalence: ~25% of women ≥65 have osteoporosis (T-score ≤ -2.5 at hip/spine); ~50% have osteopenia (T-score -1 to -2.5).
• Fracture risk: 1 in 2 women over 50 will sustain an osteoporotic fracture (hip, spine, wrist).
• Hip fracture mortality: 20–30% within 1 year; many never regain prior function.

Major Risk Factors

• Non-modifiable: Female sex, age, white/Asian ancestry, family history, prior fracture, early menopause (<45), small frame.
• Modifiable: Low calcium/vitamin D, sedentary lifestyle, smoking, excess alcohol (>2 drinks/day), low BMI (<18.5), glucocorticoid use (>3 months), certain medications (aromatase inhibitors, PPIs, SSRIs).
• Medical conditions: Rheumatoid arthritis, hyperthyroidism, celiac disease, type 1 diabetes, COPD.

Screening & Diagnosis

• DXA scan (gold standard): T-score ≤ -2.5 = osteoporosis; -1 to -2.5 = osteopenia.
• FRAX® tool estimates 10-year major osteoporotic and hip fracture probability.
• When to screen: All women ≥65; postmenopausal women <65 with risk factors.

Prevention & Treatment

• Lifestyle: Weight-bearing + resistance exercise 3×/week; balance training; fall prevention strategies.
• Nutrition: 1200 mg calcium (diet + supplement), 800–1000 IU vitamin D3 daily.
• Pharmacotherapy (if high FRAX score or prior fracture):
  • Bisphosphonates (alendronate, zoledronic acid) – first-line.
  • Denosumab (anti-RANKL) – alternative.
  • Anabolic agents (teriparatide, romosozumab) – for severe or high-risk cases.

Early detection and proactive management dramatically reduce fracture burden and preserve independence.