Osteoporosis
Also known as: Bone Loss, Low Bone Density
A condition of weakened bones and increased fracture risk. Common in rheumatology patients due to disease and medication effects. Managed with bone-protective therapies.
Key Facts
- Affects over 10 million Americans, with another 44 million at risk
- Causes approximately 2 million fractures per year in the US
- Often called a 'silent disease' — no symptoms until a fracture occurs
- Rheumatology patients are at higher risk due to inflammation and steroid use
- Hip fractures carry a 20% mortality rate within one year
What is osteoporosis?
Osteoporosis is a condition in which bones become weak and brittle, increasing the risk of fractures from minimal trauma. It’s often called a “silent disease” because bone loss occurs without symptoms until a fracture happens.
Osteoporosis is particularly relevant in rheumatology because many autoimmune conditions and their treatments (especially corticosteroids) accelerate bone loss. Rheumatologists frequently manage osteoporosis alongside the underlying inflammatory disease.
Symptoms
- Often asymptomatic until a fracture occurs
- Fragility fractures — hip, spine (compression fractures), wrist
- Loss of height over time
- Stooped or hunched posture (kyphosis)
- Back pain from vertebral compression fractures
How we diagnose it
- DEXA scan — Dual-energy X-ray absorptiometry — the standard test measuring bone mineral density at the hip and spine
- FRAX score — A fracture risk calculator incorporating age, sex, weight, smoking, steroid use, and other factors
- Blood work — Vitamin D, calcium, PTH, and sometimes bone turnover markers
- Assessment of secondary causes — Thyroid disease, vitamin D deficiency, celiac disease, medication effects (corticosteroids, aromatase inhibitors)
How we treat it
- Calcium and vitamin D — Foundational for all patients
- Bisphosphonates — Alendronate (oral) or Reclast (zoledronic acid, IV infusion administered in our infusion center annually)
- Denosumab (Prolia) — Subcutaneous injection every 6 months, administered by our medical assistant staff in-office
- Romosozumab (Evenity) — Bone-building agent for high-risk patients, administered as monthly subcutaneous injections in-office
- Teriparatide or abaloparatide — Daily injectable bone-building agents for severe osteoporosis
- Corticosteroid management — Minimizing steroid dose and duration when possible to reduce bone loss
- Fall prevention — Assessment and counseling to reduce fracture risk
At Synergy Rheumatology
Many of our patients are on medications that affect bone health. We monitor bone density, manage osteoporosis treatment alongside rheumatologic care, and administer Reclast infusions, Prolia, and Evenity on-site — no separate appointments or facilities needed.
Have questions about osteoporosis?
Schedule an appointment to discuss your symptoms, diagnosis, or treatment options with Dr. Fellows.