Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Osteoporosis
What it is
Osteoporosis is set by bone density. On a DXA scan a T-score of -2.5 or lower is the cutoff for a diagnosis of osteoporosis, while a T-score that falls between -1.0 and -2.5 is the diagnosis criterion for osteopenia, so a T-score of -2.0 lies in the osteopenic range.
Causes and risk
Relative energy deficiency in sport (RED-S), formerly known as the female athlete triad, is characterized by amenorrhea, disordered eating, and osteoporosis, and it is more common in sports that promote lean body mass. Female athletes should be screened for the disorder during their preparticipation evaluations, and individuals who present with one or more components of RED-S should be evaluated for the other components; a low BMI for age indicates an eating disorder. Osteoporosis is also one of the changes that follow menopause. The risk factors divide in two. The nonmodifiable are advanced age, female gender, white or Asian race, low peak bone mass, family history of osteoporosis, personal history of fracture, and low Body Mass Index. The modifiable are smoking, inadequate calcium intake, inadequate vitamin D, low body weight with a BMI under 21 kg/m2, estrogen deficiency, hypogonadism, and chronic glucocorticoid therapy.