Osteoporosis Diagnosis and Management: A Review from an Orthopedic Perspective

Osteoporosis is a systemic skeletal disorder characterized by low bone density and microarchitectural deterioration, both of which lead to increased risk of fracture, disability, institutionalization, and mortality. Dual-energy X-ray absorptiometry (DEXA) remains the gold standard for evaluating bone mineral density and establishing diagnostic thresholds. However, accurate interpretation requires more than the application of numerical cut-offs. Interpretation requires careful evaluation of graphical bands, artifact recognition, awareness of site discordance, and application of least significant change for precise longitudinal assessment. With a structured approach that distinguishes between universal screening from targeted testing, laboratory evaluation further complements imaging by identifying secondary causes. Although bone turnover markers offer additional value in monitoring therapeutic response, their use is limited by assay variability. From an orthopedic perspective, fragility fractures are sentinel events that highlight underlying skeletal fragility. Often the first to encounter these patients, orthopedic surgeons are uniquely positioned to initiate comprehensive evaluation and secondary prevention. This review synthesizes international guidelines and recent literature to provide a practical framework for DEXA interpretation, laboratory integration, and holistic management aimed at reducing refracture risk, improving functional outcomes, and lowering healthcare costs.