Diseases & Longevity · File 29

Osteoporosis. Silent until fracture — and hip fracture kills more than many cancers.

Osteoporosis affects 1 in 3 women and 1 in 5 men over 50. It's silent until fragility fracture. Hip fracture has approximately 20% mortality at 1 year — higher than many cancers and with sustained autonomy loss. DEXA + FRAX screening and structured intervention directly change trajectory.

Why fragility fracture is a longevity inflection point

Tsteoporosis is asymptomatic until the first fragility fracture occurs — vertebra, wrist, hip. That first fracture changes the longevity trajectory: second fracture risk multiplies by 2-5, and each subsequent fracture accelerates functional deterioration. Hip fracture is the most devastating event — approximately 20% mortality at 1 year and sustained autonomy loss in many survivors.

Screening with DEXA (bone densitometry) and FRAX tool (10-year fracture risk) is well established. USPSTF 2018 recommends screening in women ≥65 and in women <65 with significant risk factors. In men with risk factors (prolonged corticosteroid, hypogonadism, ADT for prostate cancer) it's also indicated. Modern treatment (bisphosphonates, denosumab, romosozumab, teriparatide) significantly reduces fracture risk.

A fragility fracture changes the longevity trajectory. Screening osteoporosis before it occurs is oncology-equivalent secondary prevention.
Women >50 with osteoporosis

The global weight, in numbers

Data come from IOF, USPSTF, NOF, and post-fracture mortality meta-analyses. They confirm the magnitude of the problem and screening opportunity.

  • Global prevalence

    1/3 mujeres, 1/5 hombres >50

    1 in 3 women and 1 in 5 men over 50 have osteoporosis or will experience fragility fracture. Globally, ~9 million fragility fractures occur each year.
    — IOF Compendium of Osteoporosis

  • Hip fracture mortality

    ~20% a 1 año

    Hip fracture has approximately 20% mortality at 1 year — higher than many cancers. Furthermore, 40% of survivors don't recover independent walking capacity.
    — Brauer et al., JAMA 2009

  • Refracture - amplified risk

    ×2-5 nueva fractura

    After a first fragility fracture, second fracture risk multiplies by 2-5. That makes every previous fracture an absolute treatment indication — the "fracture cascade" must be interrupted.
    — Kanis et al., Osteoporos Int 2004

  • Effective treatment

    Bisfosfonatos, denosumab, romosozumab

    Oral bisphosphonates (alendronate, risedronate) or IV (zoledronic), denosumab, and romosozumab significantly reduce vertebral and non-vertebral fracture risk. Choice depends on clinical profile, comorbidities, and individual risk. Endocrinology decision.
    — Eastell et al., Lancet 2019

Chap. 03 · Osteoporosis + sarcopenia + falls

The bone-muscle cluster and functional trajectory

Osteoporosis is rarely alone — coexists with sarcopenia, fall risk, nutritional deficits, and endocrine comorbidities. Integrated approach changes outcomes.

  • Osteosarcopenia

    Cluster amplificado

    Coexistence of osteoporosis + sarcopenia ("osteosarcopenia") significantly amplifies fracture, fall, and mortality risk. Integrated management — progressive strength training, adequate protein, vitamin D, bone treatment when indicated — changes trajectory.
    — Hassan & Duque, Curr Osteoporos Rep 2017

  • Fall risk

    Determinante de fractura

    Approximately 1 in 3 adults >65 falls each year. Risk increases with sarcopenia, polypharmacy (especially psychotropics), orthostatic hypotension, visual deficit, and cognitive decline. Structured fall risk evaluation is integral.
    — Tinetti & Kumar, JAMA 2010

  • Vitamin D deficiency

    Prevalente y modificable

    Vitamin D deficiency (<20 ng/mL) is frequent and predisposes to osteoporosis, sarcopenia, and falls. Adequate-dose supplementation (target 30-50 ng/mL) + dietary calcium are basic measures. Periodic monitoring.
    — Bischoff-Ferrari et al., NEJM 2012

  • Secondary causes

    Identificar y tratar

    Frequent secondary causes to rule out: primary hyperparathyroidism, hyperthyroidism, hypogonadism (postmenopausal women with early menopause, men with hypogonadism), prolonged corticosteroid use, celiac disease, malabsorption, RA, multiple myeloma. Their identification changes management.
    — Camacho et al., AACE 2020

What we don't offer — and what we do

Wellness Care does not prescribe bisphosphonates, denosumab, romosozumab, or teriparatide. Agent choice, titration, bisphosphonate "drug holidays" management, post-denosumab decision, and severe osteoporosis management are endocrinology / rheumatology competence. What we do: integrated cluster evaluation (osteoporosis + sarcopenia + falls + nutrition), appropriate DEXA + FRAX screening, identification of secondary causes, and coordination with endocrinology and orthopedics.

We evaluate patients with: screening indication by age and risk factors, previous fragility fracture, prolonged corticosteroid use, ADT for prostate cancer, early menopause, coexisting sarcopenia, significant fall risk, sustained vitamin D deficiency, or post-bone treatment wanting to optimize trajectory. Coordination with endocrinology, rheumatology, orthopedics, and physiatry when indicated.

Osteoporosis is not just "weak bone" — it's osteosarcopenic cluster with fall risk. Integrated intervention changes measurable outcomes.
How we measure it

How osteoporosis is evaluated
at Wellness Care

Integrated bone-muscle cluster — DEXA + FRAX + sarcopenia + fall risk + endocrine + nutrition. In coordination with endocrinology and orthopedics.

Advanced biomarkers

21 specialized panels across 8 clinical categories — biological age, inflammaging, metabolic profile, functional hormonal, microbiota. The quantitative layer.

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Functional medicine

Shared root causes — mitochondrial dysfunction, inflammaging, neuroendocrine dysregulation — before organ pathology.

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Bioregulatory medicine

Autonomic regulation, HRV, stress response. The functional trajectory that precedes clinical diagnosis.

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The Longevity Program

How this assessment integrates into the full program — from initial valuation to individualized protocol design under medical judgment.

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Featured evidence

Key evidence supporting this approach

Four publications — hip fracture mortality, modern treatment, osteosarcopenia, USPSTF screening.

«La fractura de cadera tiene una mortalidad aproximada del 20% a 1 año — mayor que muchos cánceres y con pérdida sostenida de autonomía.»
JAMA · 2009
Brauer et al., JAMA 2009
Mortalidad fractura cadera
«El tratamiento moderno de osteoporosis (bisfosfonatos, denosumab, romosozumab) reduce significativamente el riesgo de fracturas vertebrales y no vertebrales.»
Lancet · 2019
Eastell et al., Lancet 2019
Tratamiento moderno
«La osteosarcopenia — coexistencia de osteoporosis + sarcopenia — amplifica significativamente el riesgo de fracturas y mortalidad.»
Curr Osteoporos Rep · 2017
Hassan & Duque, 2017
Osteosarcopenia

Frequently asked questions about osteoporosis

The most recurrent questions about osteoporosis — DEXA screening, FRAX, modern treatments, vitamin D, and why longevity medicine integrates it as cluster.

01

When should I do the DEXA?

USPSTF 2018 recommends DEXA in:

Women:

· ≥65
· <65 with risk factors — early menopause, low body mass, family history, prolonged corticosteroid, smoking, alcohol

Men with risk factors:

· Prolonged corticosteroid
· Hypogonadism
· ADT for prostate cancer
· Previous fragility fracture

Final indication, follow-up frequency, and interpretation are endocrinology / rheumatology's.

02

What is FRAX and what is it for?

FRAX is a validated calculator that estimates 10-year fracture risk:

· Major osteoporotic fracture
· Hip fracture

Uses:

· Age, sex, weight, height
· Family history of hip fracture
· Previous fragility fracture
· Smoking, alcohol
· Corticosteroid, RA
· Secondary causes
· Optionally, femoral neck T-score

Serves to orient therapeutic decision — who benefits from treatment even with borderline T-score.

Final decision belongs to treating physician.

03

Are vitamin D and calcium enough?

Not alone.

They are indispensable basic measures:

· Vitamin D (target 30-50 ng/mL)
· Adequate dietary calcium (1000-1200 mg/day)

But in patients with established osteoporosis or high fracture risk, they do NOT replace specific pharmacological treatment:

· Bisphosphonates
· Denosumab
· Romosozumab
· Teriparatide

Essential complements:

· Strength exercise
· Fall prevention

Specific decision by endocrinology / rheumatology.

04

What secondary osteoporosis causes should be ruled out?

Frequent secondary causes:

· Primary hyperparathyroidism
· Hyperthyroidism
· Hypogonadism — early menopause, male hypogonadism, ADT
· Prolonged corticosteroid use
· Celiac disease or malabsorption
· RA or other autoimmunes
· Multiple myeloma
· Chronic kidney disease
· Type 1 diabetes
· Chronic hepatopathy
· Severe deficiency of calcium or vitamin D
· Chronic alcohol abuse

Their identification changes underlying management.

05

When should I consult?

A structured assessment is worthwhile if:

· Screening indication by age and risk factors
· Previous fragility fracture (vertebra, wrist, hip)
· Prolonged corticosteroid use
· ADT for prostate cancer
· Early menopause
· Coexisting sarcopenia
· Significant fall risk
· Sustained vitamin D deficiency
· Post-bone treatment wanting to optimize trajectory

The assessment complements endocrinology / orthopedics — does not replace them.

Before the first fracture

A fragility fracture changes the longevity trajectory. Screening osteoporosis before it occurs is the highest-impact intervention.

DEXA + FRAX per indication, osteosarcopenia and fall risk evaluation, identification of secondary causes, and coordination with endocrinology and orthopedics — that integration changes outcomes.

Bone screening or previous fragility fracture?

Book a comprehensive bone and longevity assessment

We evaluate clinical history, DEXA and FRAX indication, endocrine-metabolic profile (PTH, vitamin D, calcium, phosphorus, thyroid), body composition and sarcopenia, fall risk, nutritional factors, and 14 Lancet Commission factors when applicable. Does not replace endocrinology / orthopedics — complements them.

Book comprehensive bone assessment