Osteoporosis: Contemporary Understanding, Diagnostic Advances, and Evolving Therapeutic Strategies

Abstract Objectives: To synthesise current evidence on the epidemiology, risk factors, diagnostic strategies, and therapeutic approaches in osteoporosis, with emphasis on recent advances in risk stratification, imaging, and pharmacological management such as anabolic therapies, vitamin D analogues such as alfacalcidol, and emerging agents. Design: Narrative review of contemporary literature, including recent clinical reviews and guidelines. Data Sources: Peer‑reviewed articles and clinical guidelines identified through web search, including BMJ clinical reviews and primary care guidance. Eligibility Criteria: Articles addressing epidemiology, pathophysiology, diagnosis, fracture risk assessment, and management of osteoporosis. Results: Osteoporosis is a chronic skeletal disease associated with substantial morbidity, mortality, and economic burden. Hip fractures carry a one‑year mortality of approximately 20%. Emerging risk factors include diabetes, sarcopenia, and bariatric surgery. Advances include FRAXplus for refined risk stratification, trabecular bone score, and radiofrequency echographic multi‑spectrometry imaging. Management has shifted from BMD‑based decisions to fracture‑risk–based treatment pathways. Sequential therapy beginning with anabolic agents is increasingly recommended for highest‑risk patients. Osteoporosis remains a major global health burden. Advances include improved fracture‑risk stratification, novel imaging modalities, and a shift toward risk‑based and sequential therapy. Anabolic agents, vitamin D analogues, and emerging biologics have expanded treatment options. Conclusions: Osteoporosis remains a major public health challenge. Improved risk assessment tools, novel imaging modalities, and evolving pharmacological strategies offer opportunities for more personalised, goal‑directed care. A personalised, risk‑stratified approach integrating new diagnostics and sequential therapy offers the most effective strategy for reducing fracture burden.