Main symptoms
- •Silent disease — no symptoms before a fracture
- •Fracture after minor trauma (wrist, vertebra, hip)
- •Height loss (> 3 cm)
- •Thoracic kyphosis
- •Chronic back pain (vertebral compression)
Risk factors
- ⚠️ Age over 50 (women), over 65 (men)
- ⚠️ Menopause (oestrogen deficiency)
- ⚠️ Family history of fractures
- ⚠️ Low body weight (BMI < 19)
- ⚠️ Smoking, excessive alcohol
- ⚠️ Sedentary lifestyle
- ⚠️ Calcium and vitamin D deficiency
- ⚠️ Long-term corticosteroid therapy (> 3 months)
Management and treatments
**Foundation**: calcium (1,000-1,200 mg/day) + vitamin D3 (800-1,000 IU/day, frequent deficit in Morocco), physical activity (strength training + impact). **Specific**: bisphosphonates (alendronate, risedronate, annual IV zoledronate), denosumab (Prolia), HRT in recently menopausal women, teriparatide for severe cases. Treatment lasts 5-10 years. Reimbursement 80% by CNOPS / 70% by CNSS. Fractures may qualify as ALD.
Prevention
Calcium 1,000-1,200 mg/day (dairy, sardines, almonds), vitamin D 800-1,000 IU/day (sun + winter supplementation), physical activity from a young age, smoking cessation, limit alcohol. Bone densitometry from 65 (or 50 with risk factors). Fall prevention in seniors.
Frequently asked questions
Who should have a bone densitometry (DXA)?+
Postmenopausal women > 65 or > 50 with risk factors. Men > 70. Reimbursement 70-80% with a prescription.
Is calcium intake dangerous for the heart?+
Studies are conflicting. HAS recommends supplementation only if intake is < 800 mg/day. Favour dietary sources.
How long is the treatment?+
5-10 years depending on the molecule. Re-evaluation by DXA. A 'drug holiday' may be considered after 5 years.
Is osteoporosis reversible?+
Partially — stabilisation and slight density increase. Main goal: reduce fracture risk by up to 50%.