What causes osteoporosis and what does its diagnosis involve?

Our bones are a living organism that weakens over time.

A disease directly related to this change is osteoporosis. Osteoporosis is a disease characterized by a decrease in bone density resulting in an increased risk of bone fractures. In osteoporosis, there is a faster and greater decrease in bone density compared to the slow and small decrease that is observed with increasing age.

There are two types of cells in bones, osteoblasts which produce new bone tissue and osteoclasts which absorb old bone tissue. Normally, bones are constantly renewed and the activity of the two cell groups is in balance, while as age increases, the balance in the activity of the two cell groups is disturbed, resulting in osteopenia.

Osteopenia does not necessarily lead to osteoporosis.


What are the causes of osteoporosis?

Hormonal disorders
Estradiol reduction (women)
Decreased testosterone (men)
Alcohol abuse
Immobility or little physical activity
Long-term consumption of cola drinks (affects women and usually leads to an increased risk of hip fractures)
Chronic use of drugs such as
PPI inhibitors
Aromatase inhibitors
Serotonin Reuptake Inhibitors (SSRIs)
Antagonists of the gonadotropin-releasing hormone (GnRH inhibitors)
Cushing’s syndrome
Multiple myeloma
Celiac disease
Chronic liver disease
Excess vitamins (vitamin A, vitamin D)
Vitamin deficiency (vitamin C)


Osteoporosis is characterized as a silent and insidious disease, because patients remain asymptomatic until the first fracture occurs. Fractures usually involve bones of the spine, tibiocarpal joint and hip. In addition, loss of height and back or lower back pain may occur.

What tests are needed to diagnose osteoporosis?

Osteoporosis is diagnosed by measuring bone density with dual-energy X-ray absorptiometry (DEXA) in the lumbar spine and the proximal end of the femur.

The measurement of bone density is indicated in

women over 65 and in women 50-64 with risk factors such as a parent with a hip fracture.
women with early menopause.
men over 70 years old.
men or women who have suffered a fracture following low energy impacts (impacts that would not fracture a healthy bone).
those already receiving treatment for osteoporosis to check its effectiveness.
those who have suffered a fracture after the age of 50.
In patients with vertebral deformity.
In patients with risk factors (chronic use of cortisone, various diseases).

In addition, blood tests as well as urine tests should be carried out as they will help to diagnose the disease, identify its causes as well as monitor and evaluate the treatment.

-Levels of calcium, phosphorus, magnesium in the blood

-Vitamin D (deficiency can cause reduced absorption of calcium).

-Serum albumin

-24-hour urine calcium

– T4, TSH



-Testosterone for men

– Liver and kidney function evaluation tests

-Protein electrophoresis

-Alkaline phosphatase

-Urine hydroxyproline

-Biochemical indicators of bone metabolism

C-telopeptide (carboxy-terminal telopeptide of collagen type 1)
N-telopeptide (amino-terminal telopeptide of collagen type 1)
Amino-terminal propeptide of type I procollagen
Osteocalcin or bone protein G1a (BGP)
Alkaline phosphatase bone fraction
Tartrate-resistant acid phosphatase (TRAP)


What does osteoporosis treatment involve?

Osteoporosis treatment aims to protect and strengthen bones by increasing bone mass and inhibiting further bone loss. As a result, the risk of fractures is significantly reduced.

The treatment is individualized and is followed only on the recommendations of the attending physician.

For example, we mention that it includes:

  • Lifestyle change
  • Stop smoking
  • Reducing alcohol consumption
  • Daily exercise (mainly walking)
  • Maintaining a normal weight
  • Medication
  • Vitamin D, calcium
  • Hormone replacement therapy
  • Calcitonin (analgesic effect in acute osteoporotic spine fractures)
  • Bisphosphonates – regulators of the balance of bone metabolism
  • Monoclonal antibodies with action on bone metabolism – Denosumab, romosozumab
  • Osteoanabolics – parathyroid hormone and analogs (teriparatide, avaloparatide)
  • Strontium ranelate – treatment of first choice in postmenopausal osteoporosis