Diagnosis and Treatment of Osteoporosis

What Orthopaedic Surgeons Need to Know

Elizabeth G. Matzkin, MD; Marlene DeMaio, MD; Julia F. Charles, MD, PhD; Corinna C. Franklin, MD


J Am Acad Orthop Surg. 2019;27(20):e902-e912. 

In This Article

Abstract and Introduction


Osteoporosis, often called a silent disease, is a systemic condition of bone as a result of loss of bone mass and deterioration of its microarchitecture. The result is weakened bone, leading to an increased risk of fragility fractures. An estimated 9 million osteoporotic fractures occur every year worldwide. However, the true incidence of osteoporotic fractures is unknown because many are undetected. Astoundingly, this epidemic equates to an osteoporotic fracture every 3 seconds. Orthopaedic surgeons need to not only treat these fractures but also understand the underlying pathogenesis and risk factors to help prevent them. The management of osteoporosis is a critical part of musculoskeletal care. We must be familiar with the tools to assess osteoporosis and the treatments available, including risks and benefits. This review article is intended to deliver a review of the vast literature and provide the orthopaedic surgeon with the essential information necessary to manage the current osteoporosis epidemic.


Osteoporosis has been defined by the National Osteoporosis Foundation (NOF) as a "bone disease that occurs when the body loses too much bone, makes too little bone, or both."[1] The World Health Organization operationally defines osteoporosis as a bone mineral density (BMD) measure by a dual-energy x-ray absorptiometry (DXA) that is "2.5 standard deviations or more below the average value for young healthy women (a T-score of <−2.5 SD).[2] As bone becomes less dense and weaker, there is an increased susceptibility to fracture. In both men and women, bone mass increases until approximately age 30 years after which it starts to decline. This decline is accelerated in women after menopause secondary to the decrease in estrogen levels resulting in an approximate 2% loss in BMD each year. Women usually have a lower BMD than men to begin with, and coupled with a more rapid loss in BMD, it results in the much higher rates of osteoporosis. According to the International Osteoporosis Foundation, one in three women and one in five men older than 50 years will experience an osteoporosis-related fracture.[3] Osteopenia is defined as a T score of less than −1.0 and is estimated to effect an even higher percentage of the population.