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

Risk Factors

Multiple risk factors exist for osteoporosis and/or fractures as a result of low BMD. Nonmodifiable risk factors include female sex, white race, increasing age, and genetic/familial history. Modifiable factors include smoking (cigarettes), low body weight or body mass index, limited exercise, heavy alcohol intake, estrogen deficiency, and dietary factors such as low calcium and vitamin D intake.[8] Late menarche and early menopause have been associated with osteoporosis, as has hypogonadism in men.[9] Nutritional and hormonal compromise as a result of disordered eating or relative energy deficiency in sport can also lead to critical bone loss, including in adolescent patients.[9]

Secondary osteoporosis may be as a result of endocrine disorders such as hyperparathyroidism, hyperthyroidism, or diabetes or other diseases such as multiple myeloma, inflammatory bowel disease, inflammatory arthritis, or malabsorption.[10] Secondary localized osteoporosis may also be a result of regional radiation therapy. Medications such as glucocorticoids, anticonvulsants, aromatase inhibitors, androgen deprivation therapy, proton pump inhibitors, and selective serotonin reuptake inhibitors are associated with osteoporosis[9] (Table 2).