Senile Osteoporosis.Care & specialists in Israel

Senile osteoporosis is the age-related form of bone loss affecting adults over 70 of both sexes. It is driven by chronic vitamin D and calcium deficiency, secondary hyperparathyroidism, and reduced osteoblast activity, and produces hip, vertebral, and pelvic fractures after minimal trauma.

Postmenopausal (Type I) osteoporosis affects women in the first decade after menopause, mainly erodes trabecular bone, and produces vertebral and wrist fractures. Senile (Type II) osteoporosis occurs after age 70, affects both cortical and trabecular bone, and produces hip and pelvic fractures driven by calcium-vitamin D axis failure rather than estrogen loss.

Most patients have no symptoms before fracture. Warning signs include loss of 2 cm or more in height, new mid-back pain, progressive stooped posture, a first fragility fracture after minimal trauma (such as a wrist fracture from a fall on an outstretched hand), and difficulty rising from a chair without arms.

Diagnosis combines a fragility fracture history and DEXA scan of the hip and spine. A T-score at or below -2.5 defines osteoporosis. Any fragility fracture in an adult over 50 qualifies as clinical osteoporosis regardless of T-score. Blood tests exclude secondary causes such as vitamin D deficiency, hyperparathyroidism, or myeloma.

First-line therapy is an oral bisphosphonate (alendronate 70 mg weekly or risedronate 35 mg weekly) or intravenous zoledronic acid 5 mg yearly. Denosumab is preferred when kidney function is reduced. Severe disease starts with an anabolic agent (teriparatide or romosozumab) followed by an antiresorptive. Calcium, vitamin D, and fall prevention support every regimen.

Adults over 70 need 1,000-1,200 mg of calcium and 800-2,000 IU of vitamin D3 daily, preferably from diet plus supplements as needed. The goal is serum 25-hydroxyvitamin D above 30 ng/mL. Calcium doses above 500-600 mg at once exceed intestinal absorption capacity, so spread intake across meals.

Yes. About 6-10% of men age 75 and over have osteoporosis by DEXA criteria. One in five men over 50 will sustain a fragility fracture. One-year mortality after hip fracture is 30-40% in men, higher than in women. Men remain under-screened and under-treated despite established treatments being equally effective.

One-year mortality after hip fracture is 20-30% overall and 30-40% in men. Roughly 40-60% of survivors recover their pre-fracture walking ability. About 25% require long-term institutional care. Surgery within 24-48 hours, orthogeriatric co-management, and starting zoledronic acid before discharge lower mortality.

Bone density gains of 5-10% over 2-3 years are achievable with anabolic agents (teriparatide, abaloparatide, romosozumab) followed by anti-resorptive therapy. Bisphosphonates produce smaller gains (2-5%) but still cut hip fracture risk by 30-50%. Severe established osteoporosis is rarely returned to a fully normal T-score, but fracture risk falls dramatically.

Typical oral bisphosphonate courses last 5 years, after which low-risk patients may take a drug holiday under monitoring. Patients with persistent T-scores below -2.5 or recent fractures continue therapy for up to 10 years. Intravenous zoledronate is often given for 3 years before reassessment.

Oral bisphosphonates can cause heartburn, esophagitis, and musculoskeletal pain. Zoledronic acid causes a flu-like reaction in 30% of first doses. Rare risks include atypical femur fracture (1-2 per 10,000 person-years after 5+ years) and osteonecrosis of the jaw (under 0.1% at osteoporosis doses). Denosumab discontinuation can cause rebound vertebral fractures.

Effective measures include twice-weekly resistance and balance training (tai chi reduces falls by ~30%), home hazard removal (loose rugs, poor lighting), annual vision checks, treating cataracts, deprescribing sedating medications, well-fitted non-slip footwear, and vitamin D 800-1,000 IU/day in those with low levels.

Aim to meet 1,000-1,200 mg/day from diet first. Calcium supplements are added only if dietary intake falls short. Use elemental calcium doses of 500 mg or less per serving to maximize absorption. Some evidence links high-dose calcium supplements (above 1,000 mg/day) to cardiovascular events, so dietary calcium is preferred.

Progressive resistance training, weight-bearing aerobic activity (walking, stair climbing), tai chi, and supervised balance work are safe and effective. Avoid heavy forward-bending exercises (sit-ups, toe-touches) if vertebral fractures are present; these can cause further compression. A physiotherapist trained in osteoporosis can tailor a program.

Osteosarcopenia is the combination of osteoporosis (low bone mass) and sarcopenia (low muscle mass and strength). Together they multiply fall and fracture risk and predict worse recovery after hip fracture. Treatment combines bisphosphonates or denosumab for bone with resistance exercise and protein 1.0-1.2 g/kg/day for muscle.

Yes. New severe mid-back or low-back pain after minor exertion may indicate a vertebral compression fracture. Pain typically peaks for 4-6 weeks then settles into a chronic ache. Multiple vertebral fractures produce kyphosis, restrictive lung function, and reduced quality of life.

Repeat DEXA is generally not recommended yearly because real BMD change takes 18-24 months to detect reliably. Most guidelines suggest repeat DEXA every 1-2 years on therapy and every 2-5 years off therapy, individualized by baseline risk. Vertebral fracture imaging is added when height loss or new back pain occurs.

Yes. Mandibular bone loss accompanies systemic osteoporosis and contributes to tooth loosening and tooth loss. Bisphosphonates and denosumab can rarely cause osteonecrosis of the jaw after extractions or implant surgery (under 0.1% at osteoporosis doses), so significant dental work is best completed before starting therapy.

The US Preventive Services Task Force recommends DEXA for all women age 65 and older and for postmenopausal women under 65 with elevated risk by FRAX. For men, evidence is less robust; many guidelines recommend screening men over 70, especially with hip-fracture risk factors or prior fragility fracture.

A fracture liaison service is a coordinated program that identifies adults over 50 who sustain a fragility fracture, assesses bone density and fracture risk, prescribes anti-osteoporosis therapy, arranges follow-up, and integrates falls prevention. Fracture liaison services cut refracture rates by 30-40% and are recommended in international guidelines.

Diet alone cannot reverse established senile osteoporosis but contributes substantially to prevention. Adequate calcium (1,000-1,200 mg/day), vitamin D (800-2,000 IU/day), protein (1.0-1.2 g/kg/day), and a Mediterranean-style pattern are linked to 20-30% lower hip-fracture risk. Resistance exercise and pharmacotherapy are needed when bone density is already low.