Low bone mass + microarchitectural deterioration; T-score ≤-2.5 on DEXA.
Risk factors
- • Age, female, postmenopausal, smoking, alcohol
- • Steroids, low BMI, family history fragility fracture
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • DEXA hip + spine
- • Calcium, vitamin D, PTH, TSH, coeliac screen, myeloma screen if indicated
- • FRAX score
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Calcium 1 g + vitamin D 800 IU daily
- • Alendronate 70 mg weekly first-line
- • Denosumab 60 mg SC q6 months
- • Teriparatide / romosozumab for severe
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Weight-bearing exercise, fall prevention, stop smoking / limit alcohol
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
