Severe Osteoporosis: Complications & Management

Severe osteoporosis (T‑score ≤‑2.5 with fragility fracture) carries high morbidity.

Major Complications

• Fragility Fractures: Hip (most devastating), vertebral (compression), wrist, humerus, pelvis.
• Chronic Pain: Vertebral fractures → kyphosis, height loss, restrictive lung disease.
• Disability & Loss of Independence: Hip fracture → 50% never regain prior function; 20‑30% 1‑yr mortality.
• Psychosocial: Fear of falling, depression, social isolation.

Management Pillars

1. Pharmacotherapy: Bisphosphonates, denosumab, romosozumab (anabolic), teriparatide/abaloparatide. Choose per fracture risk, renal function.
2. Calcium/Vitamin D: 1200 mg Ca²⁺ (diet+supp), 800‑2000 IU D3.
3. Exercise: Weight‑bearing + resistance + balance (Tai Chi) 3×/wk.
4. Fall Prevention: Home safety, vision check, medication review, hip protectors.
5. Vertebral Fracture Assessment (VFA): Detect silent fractures.

Monitoring

DEXA every 1‑2 y; bone turnover markers; adherence counseling.