Osteoporosis in adults: diagnosis, prevention, and treatment – a narrative review
Abstract
Objective: To synthesize current evidence on the diagnosis, prevention, pharmacological treatment, and long-term management of osteoporosis in adults.
Methods: PubMed/MEDLINE and reference lists of major guidelines, position statements, systematic reviews, meta-analyses, and pivotal randomized trials were searched, with emphasis on evidence published from 2022 to 2026 and inclusion of older landmark trials when clinically relevant.
Findings: Contemporary assessment integrates dual-energy X-ray absorptiometry (DXA) with fracture history, clinical risk factors, FRAX, vertebral imaging, and evaluation for secondary causes. Prevention combines adequate nutrition, correction of vitamin D deficiency, exercise, fall prevention, smoking cessation, and avoidance of excessive alcohol. Bisphosphonates and denosumab remain major antiresorptive therapies, whereas teriparatide, abaloparatide, and romosozumab are important options for selected patients at very high fracture risk. Treatment sequencing and planned antiresorptive therapy after anabolic treatment or denosumab discontinuation are central to long-term care.
Conclusions: Osteoporosis management should be individualized according to absolute and imminent fracture risk. The principal therapeutic goal is prevention of fragility fractures and preservation of function rather than improvement in BMD alone.
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